多模式镇痛下持续髂筋膜间隙阻滞与收肌管阻滞对老年人全膝关节置换术后镇痛及早期康复的影响

Influence of Continuous Fascia Iliaca Compartment Block and Adductor Canal Block with Multimodal Analgesia on Postoperative Analgesia and Early Rehabilitation after Elderly TKA Surgery

目的观察多模式镇痛下持续髂筋膜间隙阻滞(fascia iliaca compartment block, FICB)和收肌管阻滞(adductor canal block,ACB)在老年人全膝关节置换(total knee arthroplasty,TKA)术后镇痛效果及对早期康复的影响。方法选择60例行TKA术患者(男34例,女26例),年龄60～75岁。随机分为两组,术后超声引导下0.25%罗哌卡因240 mL自控镇痛泵连续FICB 30例与连续ACB 30例。所有患者以前均未做过膝关节手术。记录TKA术后6、12、24、48 h静息状态和被动屈膝时视觉模拟评分(visual analogue scale,VAS),不同时间评定术后康复训练依从性、膝关节主动活动度(range of motion, ROM)、膝关节功能。结果 ACB组与FICB组患者术后6、12、24、48 h静息痛、活动痛的VAS评分差异无统计学意义(P>0.05)。ACB组与FICB组术后康复训练依从性、膝关节ROM及HSS评分比较,差异均有统计学意义(P<0.05)。结论超声引导下持续ACB可促进TKA术后早期康复。

Objective To observe the analgesia efficacy of continuous fascia iliaca compartment block(FICB)and adductor canal block(ACB)on elderly patients undergoing total knee arthroplasty(TKA)with multimodal analgesia and their early rehabilitation.Methods Sixty TKA patients(26 female and 34 male,60-75 years old)were randomly divided into two groups and received ultrasound-guided either continuous FICB(n=30)or continuous ACB(n=30)using 0.25%ropivacaine for controlled analgesia.All the patients had no previous experiences of knee surgery.Quality of analgesia was assessed by dynamic and static visual analogue scale(VAS)based on pain intensity.In addition,rehabilitation training compliance,range of motion(ROM)and knee function were assessed at different times after rehabilitation training.Results No significant differences were found in VAS scores during resting and passive functional exercise at 6,12,24,48 h after TKA surgery(P>0.05);ACB group had significant differences in rehabilitation training compliance,knee ROM and HSS scores in comparison with FICB group(P<0.05).Conclusions Ultrasound-guided continuous ACB with multimodal analgesia could promote early rehabilitation after TKA.