股神经阻滞联合罗哌卡因关节腔注射用于全膝关节置换术后镇痛的临床效果

Effect of femoral nerve block combined with ropivacaine intra-articular injection for analgesia after total knee arthroplasty

目的:探讨股神经阻滞联合罗哌卡因关节腔注射用于全膝关节置换术(total knee arthroplasty,TKA)后镇痛的临床效果。方法:纳入行TKA治疗的108例患者为研究对象。按照镇痛方式的不同将患者分为A组、B组和C组,每组各36例。A组采用关节腔注射罗哌卡因镇痛;B组采用股神经阻滞(罗哌卡因)镇痛;C组采用关节腔注射罗哌卡因联合股神经阻滞镇痛。比较各组术后6 h、12 h、1 d、2 d静息及运动状态下疼痛情况[视觉模拟疼痛评分(visual analogue scale,VAS)]、各组镇痛时间及术后48 h内芬太尼用量、各组术后膝关节早期功能恢复情况,并记录术后48 h内镇痛相关不良反应发生情况。结果:C组静息及运动状态下各时间点VAS评分均低于A组和B组(P<0.05);在静息状态下A组和B组各时间点VAS评分差异均无统计学意义(P>0.05);在运动状态下,B组在术后12 h及术后1 d时低于A组(P<0.05)。C组镇痛持续时间长于A组及B组(P<0.05),C组48 h镇痛药芬太尼用量少于A组和B组(P<0.05)。C组膝关节主动屈曲60°与90°时间及术后首次下床活动时间均早于A组和B组(P<0.05),C组术后两周膝关节主动屈曲最大角度大于A组和B组(P<0.05)。各组患者术后48 h内镇痛相关不良反应总发生率无统计学差异(P>0.05)。结论:股神经阻滞联合罗哌卡因关节腔注射在不增加不良反应的基础上可为TKA患者提供充分术后镇痛效果。

Objective:To investigate the analgesic effect of femoral nerve block combined with ropivacaine intra-articular injection after total knee arthroplasty(TKA).Methods:A total of 108 patients who underwent TKA were selected as subjects.The patients were divided into group A,group B and group C according to the different ways of analgesia,36 cases in each group.Group A received intra-articular injection of ropivacaine for analgesia,group B received femoral nerve block(ropivacaine)for analgesia,and group C was given intra-articular injection of ropivacaine combined with femoral nerve block for analgesia.The pain at rest and during exercise at 6 h,12 h,1 d and 2 d after operation[visual analogue pain score(VAS)],analgesia time and fentanyl dosage at 48 h after operation,early functional recovery of knee joint after operation were compared among the three groups,and the adverse reactions related to analgesia within 48 h after operation were recorded.Results:The VAS scores at rest and during exercise in group C were lower than those in group A and group B(P<0.05).There was no statistically significant difference in VAS scores between group A and group B at each time point in the resting state(P>0.05).In the exercise state,the VAS score of group B was lower than that of group A at 12 h and 1 d after operation(P<0.05).The duration of analgesia in group C was longer than that in group A and group B(P<0.05),and the dosage of fentanyl in 48 h was less than that in group A and group B(P<0.05).The time of active knee flexion 60°,active knee flexion 90°and the first time of getting out of bed after operation in group C were earlier than those in group A and group B(P<0.05).The maximum angle of active knee flexion 2 weeks after operation in group C was greater than that in group A and group B(P<0.05).There was no significant difference in the incidence of analgesia-related adverse reactions within 48 hours after operation among the three groups(P>0.05).Conclusion:Femoral nerve block combined with ropivacaine intra-articular injection can provide sufficient postoperative analgesia for TKA patients without increasing the incidence of adverse reactions.