超声引导下近端收肌管阻滞联合远端IPACK阻滞应用于全膝关节置换术后的效果

Effect of Ultrasound-guided Proximal Adductor Canal Block Combined with Distal Ipack Block after Total Knee Arthroplasty

目的:探讨超声引导下近端收肌管阻滞联合远端腘动脉与膝关节后囊间隙(IPACK)阻滞对全膝关节置换术患者的影响。方法:选取2021年12月—2023年12月蚌埠医科大学第一附属医院行全膝关节置换术的60例患者作为研究对象,根据手术先后顺序随机分为对照组和观察组,每组各30例。对照组行超声引导下近端收肌管阻滞,观察组在对照组基础上行IPACK阻滞。比较两组临床指标、术后疼痛情况、下肢肌力情况及不良反应发生情况。结果:术后观察组首次行走距离长于对照组,首次下床活动时间短于对照组,自控静脉镇痛泵按压次数低于对照组,差异有统计学意义(P<0.05)。两组手术时间、术中舒芬太尼用量、不良反应发生率比较,差异无统计学意义(P>0.05)。术后12 h、24 h、48 h,两组小腿三头肌和股四头肌肌力均增加,且观察组高于对照组,差异有统计学意义(P<0.05)。术后6 h、12 h、24 h,观察组静息和活动时视觉疼痛模拟量表评分均低于对照组,差异有统计学意义(P<0.05);术后48 h,两组视觉疼痛模拟量表评分比较,差异无统计学意义(P>0.05)。结论:超声引导下近端收肌管阻滞联合远端IPACK阻滞对全膝关节置换术患者下肢肌力影响较小,具有较好的镇痛效果,可促进术后快速恢复,安全性好。

Objective:To investigate the effect of ultrasound-guided proximal adductor canal block combined with distal infiltration between the popeliteal artery and capsule of the knee(IPACK)block in patients undergoing total knee arthroplasty.Method:60 patients who underwent total knee replacement in the First Affiliated Hospital of Bengbu Medical University from December 2021 to December 2023 were selected as the study objects and randomly divided into control group and observation group according to the order of surgery,with 30 cases in each group.The control group was treated with ultrasound-guided proximal adductor canal block while the observation group was treated with distal IPACK block on the basis of control group.The clinical indexes,postoperative pain,lower limb muscle strength and adverse reactions were compared between the two groups.Result:The first walking distance in the observation group was higher than the control group,the first time to get out of bed after operation and the times of pressing the patient-controlled intravenous analgesia pump were lower than control group,the differences were statistically significant(P<0.05).There was no significant difference in operation time,intraoperative sufentanil dosage and incidence of adverse reactions between the two groups(P>0.05).12 h,24 h and 48 h after operation,the muscle strength of triceps femoris and quadriceps femoris increased in both groups,the observation group was higher than control group,the differences were statistically significant(P<0.05).6 h,12 h and 24 h after operation,the scores of VAS in the observation group were lower than the control group,the differences were statistically significant(P<0.05).48 h after operation,there was no significant difference in the comparison of VAS scores between the two group(P<0.05).Conclusion:Ultrasoundguided proximal adductor canal block combined with distal IPACK block has less effect on lower limb muscle strength in patients undergoing total knee arthroplasty,has better analgesic effect,can promote rapid postoperative recovery,and has good safety.