亚甲蓝复合罗哌卡因隐神经阻滞对全膝关节置换术患者术后镇痛效果的影响

Effect of methylene blue combined with ropivacaine for saphenous nerve block on postoperative analgesia in patients undergoing total knee arthroplasty

目的探讨应用亚甲蓝复合罗哌卡因隐神经阻滞对全膝关节置换术(TKA)患者术后镇痛效果的影响。方法选择择期行全膝关节置换术患者60例,男24例,女36例,年龄60~75岁,BMI 18.5~30.0 kg/m^(2),ASAⅡ或Ⅲ级。采用随机数字表法将患者分为两组:亚甲蓝复合罗哌卡因组(MR组)和罗哌卡因组(R组),每组30例。腰-硬联合麻醉前,MR组采用0.10%亚甲蓝+0.25%罗哌卡因复合液20 ml行超声引导下隐神经阻滞,R组采用0.25%罗哌卡因20 ml行超声引导下隐神经阻滞。记录术后6、12、24、48、72 h患肢静息和活动时VAS疼痛评分,术后24、48、72 h患肢膝关节最大活动度(ROM)和股四头肌徒手肌力检查(MMT)评分,镇痛泵有效按压次数、补救镇痛例数和补救镇痛药首次追加时间。记录穿刺部位出血、感染、局部麻醉药物中毒、神经损伤、周围组织损伤等神经阻滞相关并发症的发生情况。结果与R组比较,MR组术后12、24、48、72 h静息时VAS疼痛评分明显降低(P<0.05),术后48、72 h活动时VAS疼痛评分明显降低(P<0.05),术后24、48、72 h患肢膝关节ROM明显增大(P<0.05),镇痛泵有效按压次数明显减少(P<0.05),补救镇痛率明显降低(P<0.05)。两组术后住院期间均未见神经阻滞相关并发症。结论超声引导下亚甲蓝复合罗哌卡因隐神经阻滞可增强TKA术后镇痛效果,延长镇痛作用时间,减少术后镇痛药的使用,有利于术后早期膝关节的功能锻炼。

Objective To explore the effect of methylene blue combined with ropivacaine for saphenous nerve block on the postoperative analgesia in patients undergoing total knee arthroplasty.Methods Sixty patients were selected for elective TKA,24 males and 36 females,aged 60-75 years,BMI 18.5-30.0 kg/m^(2),ASA physical statusⅡorⅢ.The patients were divided into two groups using randomized numerical table method:methylene blue combined with ropivacaine group(group MR)and ropivacaine group(group R),30 patients in each group.Ultrasound-guided saphenous nerve block was performed with 0.10%methylene blue+0.25%ropivacaine composite 20 ml in group MR,and ultrasound-guided saphenous nerve block was performed with 0.25%ropivacaine 20 ml in group R before the combined spinal-epidural anesthesia.The VAS pain scores at rest and during activity at 6,12,24,48,and 72 hours postoperatively,the maximum range of motion mobility(ROM)of the knee joint of the affected limb,the quadriceps unarmed manual muscle test(MMT)scores at 24,48,and 72 hours postoperatively,the effective number of analgesic pump presses,and the time of the first additional time of the remedial analgesic were recorded.The complications related to nerve block,such as bleeding,infection,local anesthetic poisoning,nerve injury,and peripheral tissue injury were recorded.Results Compared with group R,the VAS pain score at rest was significantly lower in group MR at 12,24,48,and 72 hours postoperatively(P<0.05).Compared with group R,the VAS pain scores during activity were significantly lower in the group MR at 48 and 72 hours postoperatively(P<0.05).Compared with group R,ROM of the knee joint of the affected limb was significantly greater in group MR at 24,48,and 72 hours postoperatively(P<0.05).The effective number of analgesic pump presses and the rate of remedial analgesia were significantly lower in the group MR compared with group R(P<0.05).There were no complications related to nerve block during hospital stay in both groups.Conclusion Ultrasound-guided methylene blue combined with ropivacaine for saphenous nerve block can enhance the postoperative analgesic effect,prolong the duration of analgesia,reduce the use of postoperative analgesics,and facilitate the functional exercise of the knee joint in the early postoperative period.