超声引导下腘窝坐骨神经联合收肌管阻滞用于膝关节置换手术镇痛的效果评价

Effect of ultrasound-guided popliteal sciatic nerve combined with adductor canal block for analgesia in knee replacement surgery

目的评价超声引导下腘窝坐骨神经联合收肌管阻滞用于膝关节置换手术镇痛的临床效果。方法选取2020年1月至2023年7月在湖州市南浔区人民医院择期行单侧膝关节置换手术的60例患者纳入研究,按随机数表法分为A组和B组,每组30例。A组患者全麻前超声引导下行腘窝坐骨神经阻滞,B组患者全麻前超声引导下行腘窝坐骨神经联合收肌管阻滞;两组患者均行术后静脉镇痛。比较两组患者的感觉阻滞起效时间及维持时间、运动阻滞起效时间及维持时间、麻醉诱导前、手术切皮时和手术结束时的血流动力学;同时比较两组患者术后4 h、8 h、24 h和36 h的视觉模拟评分(VAS),以及术后36 h内的镇痛泵首次按压时间和镇痛泵有效按压次数。结果B组患者的感觉阻滞起效时间为(11.88±0.27)min,明显短于A组的(14.1±10.22)min,感觉阻滞维持时间为(747.00±23.08)min,明显长于A组的(571.90±17.98)min,差异均有统计学意义(P<0.05);但两组的运动阻滞起效时间和运动阻滞维持时间比较差异均无统计学意义(P>0.05);B组患者在手术切皮时、手术结束时的心率分别为(69.38±5.2)次/min、(66.79±4.73)次/min,明显低于A组的(72.97±5.2)次/min、(69.40±5.06)次/min,而平均动脉压分别为(92.91±8.08)mm Hg、(94.67±8.69)mm Hg,明显高于A组的(89.29±7.58)mmHg、(86.70±7.28)mmHg,差异均有统计学意义(P<0.05);术后8 h、24 h、36 h,B组患者的VAS评分分别为(4.12±0.06)分、(3.42±0.12)分、(2.44±0.10)分,明显低于A组的(4.87±0.15)分、(4.61±0.09)分、(3.47±0.16)分,差异均有统计学意义(P<0.05);术后36 h内,B组患者的静脉自控镇痛泵首次按压时间为(306.8±0.90)min,明显长于A组的(177.3±1.47)min,差异均有统计学意义(P<0.05);术后24 h、36 h,B组患者镇痛泵有效按压次数分别为(1.35±0.04)次、(2.55±0.09)次,明显少于A组的(1.66±0.05)次、(3.48±0.09)次,差异均有统计学意义(P<0.05)。结论超声引导下腘窝坐骨神经联合收肌管阻滞能提升膝关节置换手术患者的麻醉效率,维持血流动力学稳定,同时确保围手术期镇痛效果,使术后自控镇痛应用频率降低。

Objective To evaluate the clinical effect of ultrasound-guided popliteal sciatic nerve combined with adductor canal block for analgesia in knee replacement surgery.Methods Sixty patients scheduled for unilateral knee arthroplasty in Nanxun District People's Hospital of Huzhou City from January 2020 to July 2023 were included in the study.They were divided into group A and group B according to the random number table method,with 30 cases in each group.Ultrasound-guided popliteal sciatic nerve block was performed in group A before general anesthesia,and ul-trasound-guided popliteal sciatic nerve combined with adductor canal block was performed in group B before general an-esthesia.Both groups of patients underwent postoperative intravenous analgesia.The onset time and maintenance time of sensory block,the onset time and maintenance time of motor block,and the hemodynamics before anesthesia induction,at skin incision,and at the end of operation were compared between the two groups.At the same time,the Visual Ana-logue Scale(VAS)at 4 h,8 h,24 h,and 36 h after operation,the first pressing time of analgesic pump,and the effective pressing times of analgesic pump within 36 h after operation were compared between the two groups.Results The on-set time of sensory block in group B was(11.88±0.27)min,which was significantly shorter than(14.1±10.22)min in group A,and the maintenance time of sensory block was(747.00±23.08)min,which was significantly longer than(571.90±17.98)min in group A,with statistically significant differences(P<0.05).However,there was no significant dif-ference in the onset time and the maintenance time of motor block between the two groups(P>0.05).The heart rates of patients in group B were(69.38±5.2)times/min and(66.79±4.73)times/min at the time of skin incision and at the end of operation,which were significantly lower than(72.97±5.2)times/min and(69.40±5.06)times/min in group A;the mean arterial pressure was(92.91±8.08)mmHg and(94.67±8.69)mmHg,respectively,which were significantly higher than(89.29±7.58)mmHg and(86.70±7.28)mmHg in group A;the differences were statistically significant(P<0.05).At 8 h,24 h,and 36 h after operation,the VAS scores of group B were(4.12±0.06)points,(3.42±0.12)points,and(2.44±0.10)points,respectively,which were significantly lower than(4.87±0.15)points,(4.61±0.09)points,and(3.47±0.16)points of group A(P<0.05).Within 36 hours after operation,the first pressing time of patient-controlled intravenous analgesia pump in group B was(306.8±0.90)min,which was significantly longer than(177.3±1.47)min in group A(P<0.05).At 24 h,36 h after surgery,the effective compression times of analgesic pump in group B were(1.35±0.04)times and(2.55±0.09)times,respectively,which were significantly less than(1.66±0.05)times and(3.48±0.09)times in group A(P<0.05).Conclusion Ultrasound-guided popliteal sciatic nerve combined with adductor canal block can improve the anes-thesia efficiency of patients undergoing knee replacement surgery,maintain hemodynamic stability,ensure perioperative analgesic effect,and reduce the frequency of postoperative patient-controlled analgesia.