Good perioperative analgesia following total knee arthroplasty facilitates rehabilitation and may reduce hospital stay. We present the patient analgesic requirements and rehabilitation of a prospective single surgeon ...Good perioperative analgesia following total knee arthroplasty facilitates rehabilitation and may reduce hospital stay. We present the patient analgesic requirements and rehabilitation of a prospective single surgeon series after the introduction of a multimodal drug injection during his total knee arthroplasty. Basic epidemiological data as well as analgesic, antiemetic requirements and time to straight leg raised was collected on 27 consecutive patients (group 1) whom received the multimodal drug injection, consisting of levobupivacaine, ketorolac and adrenaline at the time of their total knee arthroplasty under spinal anaesthesia. Their rehabilitation was compared to a retrospective review of patients who were case matched by age and sex (group 2n = 26), whom had received the unit standard of spinal anaesthetic and a femoral and sciatic block at the time of their operation. Patients in group 1 had significantly lower analgesic and antiemetic requirements than group 2. Group 1 also had a significantly shorter hospital stay. We have demonstrated that periarticular multimodal drug injection can improve perioperative analgesia and mobilisation following total knee arthroplasty as well as reducing opioid requirements and side effects.展开更多
Background There are several methods for postoperative analgesia for knee surgery.The commonly utilized method is multimodal analgesia based on continuous femoral nerve block.The aim of this study was to investigate t...Background There are several methods for postoperative analgesia for knee surgery.The commonly utilized method is multimodal analgesia based on continuous femoral nerve block.The aim of this study was to investigate the application of continuous adductor canal block for analgesia after total knee replacement and compare this method with continuous femoral nerve block.Methods Sixty patients scheduled for total knee replacement from June 2013 to March 2014 were randomly divided into a femoral group and an adductor group.Catheters were placed under the guidance of nerve stimulation in the femoral group and under the guidance of ultrasound in the adductor group.Operations were performed under combined spinal and epidural anesthesia.After the operations,0.2％ ropivacaine was given at a speed of 5 ml/h through catheters in all patients.Visual analogue scale （VAS） pain scores at rest and while moving were noted at 4,24,and 48 hours after the operation,and quadriceps strength was also assessed at these time-points.Secondary parameters such as doses of complementary analgesics and side effects were also recorded.Results There were no significant differences between the groups in VAS pain scores at rest or while moving,at 4,24,or 48 hours after the operation （P ＞0.05）.At these time-points,mean quadriceps strengths in the adductor group were 3.0 （2.75-3.0）,3.0 （3.0-4.0）,and 4.0 （3.0-4.0）,respectively,all of which were significantly stronger than the corresponding means in the femoral group,which were 2.0 （2.0-3.0）,2.0 （2.0-3.0）,and 3.0 （2.0-4.0）,respectively （P ＜0.05）.There were no significant differences between the groups in doses of complementary analgesics or side effects （P ＞0.05）.X-ray images of some patients showed that local anesthetic administered into the adductor canal could diffuse upward and reach the femoral triangle.Conclusions Continuous adductor canal block with 0.2％ ropivacaine could be used effectively for analgesia after total knee replacement.Compared with continuous femoral nerve block,this analgesic method has similar analgesic effects and is associated with less weakness of quadriceps muscle.展开更多
目的探讨对老年人全膝关节置换术患者在多模式镇痛下分别给予超声引导下持续髂筋膜间隙阻滞以及收肌管阻滞对术后快速康复的影响。方法随机选取2020年2月—2022年11月常州市中医医院收治的60例老年人全膝关节置换术患者为研究对象,以随...目的探讨对老年人全膝关节置换术患者在多模式镇痛下分别给予超声引导下持续髂筋膜间隙阻滞以及收肌管阻滞对术后快速康复的影响。方法随机选取2020年2月—2022年11月常州市中医医院收治的60例老年人全膝关节置换术患者为研究对象,以随机数表法分为研究组和参照组,每组30例。参照组在多模式镇痛基础下施以超声引导下持续髂筋膜间隙阻滞,研究组在多模式镇痛基础下施以超声引导下持续收肌管阻滞。对比两组患者动态视觉模拟评分法(Visual Analogue Scale,VAS)评分、术后各时间点静息状态VAS评分、美国特种外科医院膝关节评分量表(Hospital for Special Surgery Knee Score,HSS)评分以及膝关节关节活动度(Range of Motion,ROM)。结果术后6、12、24、48 h,两组VAS评分比较,差异无统计学意义(P均>0.05)。研究组HSS评分为(71.25±7.25)分,高于参照组的(63.55±6.79)分,差异有统计学意义(t=4.246,P<0.05)。术后3、7、10、12 d,研究组ROM均高于参照组,差异有统计学意义(P均<0.05)。结论临床对老年人全膝关节置换术患者在给予镇痛干预期间,同超声引导下持续髂筋膜间隙阻滞比较,超声引导下持续收肌管阻滞方法的有效应用,可对患者的术后早期康复给予明显促进。展开更多
目的观察耳穴疗法用于全膝关节置换术围手术期镇痛的效果。方法选择ASAⅠ～Ⅲ级行单侧全膝关节置换骨性关节炎患者60例,随机分为耳穴镇痛组和对照组,每组30例,所有患者手术均由同一组医师施行,实施气管插管全身麻醉。耳穴镇痛组患者术...目的观察耳穴疗法用于全膝关节置换术围手术期镇痛的效果。方法选择ASAⅠ～Ⅲ级行单侧全膝关节置换骨性关节炎患者60例,随机分为耳穴镇痛组和对照组,每组30例,所有患者手术均由同一组医师施行,实施气管插管全身麻醉。耳穴镇痛组患者术前用王不留行籽按压耳穴配合术后患肢局部穴位敷贴镇痛,对照组采用常规治疗,两组患者均术前1天口服塞来昔布400 mg,术后口服塞来昔布每日2次,每次200 mg。当视觉模拟评分(visual analogue scales,VAS)>7分时,予盐酸布桂嗪0.1 g补救。术后两组采用相同的锻炼方法。记录静息时的VAS评分,镇静满意度,发生不良反应情况,术后膝关节活动度(range of motion,ROM)及美国特种外科医院膝关节评分(hospital for special surgery scores,HSS)。结果耳穴镇痛组患者术后6、24 h的静息VAS疼痛评分分别为(5.99±0.67)、(4.26±0.59)分,均明显低于对照组患者(7.02±0.85,4.92±0.43,P<0.01);两组患者术后1、48 h VAS评分差异无统计学意义(P>0.05);两组患者镇静满意程度总体相似;与对照组比较,耳穴镇痛组患者并发症发生率减少,但差异无统计学意义(4:11,P>0.05);ROM和HSS评分方面,耳穴镇痛组术前ROM为75.63°±5.74°,对照组术前ROM为75.43°±5.63°,差异无统计学意义(P>0.05);耳穴镇痛组术后2周主动与被动ROM分别为96.50°±3.79°、107.8°±3.37°,对照组分别为93.50°±3.50°、105.27°±3.25°,均有统计学意义(P<0.05);耳穴镇痛组术前HSS评分为(60.23±3.44)分,对照组为(61.70±2.83)分,差异无统计学意义(P>0.05);术后HSS评分分别为(86.97±2.33)、(85.37±2.30)分,差异有统计学意义(P<0.05)。结论膝关节置换术围手术期配合应用耳穴疗法有助于减轻患者的术后疼痛,减少术后总的麻醉剂使用量,有助于患者的早期康复,同时有着费用低、并发症少、操作简单、安全的优点。展开更多
文摘Good perioperative analgesia following total knee arthroplasty facilitates rehabilitation and may reduce hospital stay. We present the patient analgesic requirements and rehabilitation of a prospective single surgeon series after the introduction of a multimodal drug injection during his total knee arthroplasty. Basic epidemiological data as well as analgesic, antiemetic requirements and time to straight leg raised was collected on 27 consecutive patients (group 1) whom received the multimodal drug injection, consisting of levobupivacaine, ketorolac and adrenaline at the time of their total knee arthroplasty under spinal anaesthesia. Their rehabilitation was compared to a retrospective review of patients who were case matched by age and sex (group 2n = 26), whom had received the unit standard of spinal anaesthetic and a femoral and sciatic block at the time of their operation. Patients in group 1 had significantly lower analgesic and antiemetic requirements than group 2. Group 1 also had a significantly shorter hospital stay. We have demonstrated that periarticular multimodal drug injection can improve perioperative analgesia and mobilisation following total knee arthroplasty as well as reducing opioid requirements and side effects.
文摘Background There are several methods for postoperative analgesia for knee surgery.The commonly utilized method is multimodal analgesia based on continuous femoral nerve block.The aim of this study was to investigate the application of continuous adductor canal block for analgesia after total knee replacement and compare this method with continuous femoral nerve block.Methods Sixty patients scheduled for total knee replacement from June 2013 to March 2014 were randomly divided into a femoral group and an adductor group.Catheters were placed under the guidance of nerve stimulation in the femoral group and under the guidance of ultrasound in the adductor group.Operations were performed under combined spinal and epidural anesthesia.After the operations,0.2％ ropivacaine was given at a speed of 5 ml/h through catheters in all patients.Visual analogue scale （VAS） pain scores at rest and while moving were noted at 4,24,and 48 hours after the operation,and quadriceps strength was also assessed at these time-points.Secondary parameters such as doses of complementary analgesics and side effects were also recorded.Results There were no significant differences between the groups in VAS pain scores at rest or while moving,at 4,24,or 48 hours after the operation （P ＞0.05）.At these time-points,mean quadriceps strengths in the adductor group were 3.0 （2.75-3.0）,3.0 （3.0-4.0）,and 4.0 （3.0-4.0）,respectively,all of which were significantly stronger than the corresponding means in the femoral group,which were 2.0 （2.0-3.0）,2.0 （2.0-3.0）,and 3.0 （2.0-4.0）,respectively （P ＜0.05）.There were no significant differences between the groups in doses of complementary analgesics or side effects （P ＞0.05）.X-ray images of some patients showed that local anesthetic administered into the adductor canal could diffuse upward and reach the femoral triangle.Conclusions Continuous adductor canal block with 0.2％ ropivacaine could be used effectively for analgesia after total knee replacement.Compared with continuous femoral nerve block,this analgesic method has similar analgesic effects and is associated with less weakness of quadriceps muscle.
文摘目的探讨对老年人全膝关节置换术患者在多模式镇痛下分别给予超声引导下持续髂筋膜间隙阻滞以及收肌管阻滞对术后快速康复的影响。方法随机选取2020年2月—2022年11月常州市中医医院收治的60例老年人全膝关节置换术患者为研究对象,以随机数表法分为研究组和参照组,每组30例。参照组在多模式镇痛基础下施以超声引导下持续髂筋膜间隙阻滞,研究组在多模式镇痛基础下施以超声引导下持续收肌管阻滞。对比两组患者动态视觉模拟评分法(Visual Analogue Scale,VAS)评分、术后各时间点静息状态VAS评分、美国特种外科医院膝关节评分量表(Hospital for Special Surgery Knee Score,HSS)评分以及膝关节关节活动度(Range of Motion,ROM)。结果术后6、12、24、48 h,两组VAS评分比较,差异无统计学意义(P均>0.05)。研究组HSS评分为(71.25±7.25)分,高于参照组的(63.55±6.79)分,差异有统计学意义(t=4.246,P<0.05)。术后3、7、10、12 d,研究组ROM均高于参照组,差异有统计学意义(P均<0.05)。结论临床对老年人全膝关节置换术患者在给予镇痛干预期间,同超声引导下持续髂筋膜间隙阻滞比较,超声引导下持续收肌管阻滞方法的有效应用,可对患者的术后早期康复给予明显促进。
文摘目的 探讨收肌管阻滞(ACB)联合静脉自控镇痛(PCIA)对行全膝关节置换术患者术后抑郁状态的影响。方法选择行全膝关节置换术的患者随机分为ACB联合PCIA组(A组)40例和PCIA组(B组)40例。B组术后给予PCIA镇痛方法,A组在B组基础上术前联合ACB镇痛。记录术后2 h(T_(1))、6 h(T_(2))、12 h(T_(3))、24 h(T_(4))、72 h(T_(5))静息和运动VAS评分,术后补救镇痛药物使用情况,恶心呕吐发生情况,术前、术后1 d、术后3 d医院焦虑抑郁量表(HADS)评分。结果A组患者T1~T4时静息和运动VAS评分明显低于B组(P<0.05);A组患者术后补救镇痛药物使用量明显减少(P<0.05),恶心呕吐发生率明显降低(P<0.05);A组患者术后1 d HADS评分及术后出现显著的抑郁症状(HADS-D≥8)的患者比例明显低于B组(P<0.05);术后1 d HADS评分与T1~T4时静息和运动VAS评分呈明显正相关(P<0.05);术后3 d HADS评分与T_(1)~T_(3)时静息和运动VAS评分呈明显正相关(P<0.05)。结论ACB联合PCIA相比单纯PCIA在全膝关节置换术后镇痛效果更加显著,并可减少术后抑郁的发生,促进患者快速康复。
文摘目的观察耳穴疗法用于全膝关节置换术围手术期镇痛的效果。方法选择ASAⅠ～Ⅲ级行单侧全膝关节置换骨性关节炎患者60例,随机分为耳穴镇痛组和对照组,每组30例,所有患者手术均由同一组医师施行,实施气管插管全身麻醉。耳穴镇痛组患者术前用王不留行籽按压耳穴配合术后患肢局部穴位敷贴镇痛,对照组采用常规治疗,两组患者均术前1天口服塞来昔布400 mg,术后口服塞来昔布每日2次,每次200 mg。当视觉模拟评分(visual analogue scales,VAS)>7分时,予盐酸布桂嗪0.1 g补救。术后两组采用相同的锻炼方法。记录静息时的VAS评分,镇静满意度,发生不良反应情况,术后膝关节活动度(range of motion,ROM)及美国特种外科医院膝关节评分(hospital for special surgery scores,HSS)。结果耳穴镇痛组患者术后6、24 h的静息VAS疼痛评分分别为(5.99±0.67)、(4.26±0.59)分,均明显低于对照组患者(7.02±0.85,4.92±0.43,P<0.01);两组患者术后1、48 h VAS评分差异无统计学意义(P>0.05);两组患者镇静满意程度总体相似;与对照组比较,耳穴镇痛组患者并发症发生率减少,但差异无统计学意义(4:11,P>0.05);ROM和HSS评分方面,耳穴镇痛组术前ROM为75.63°±5.74°,对照组术前ROM为75.43°±5.63°,差异无统计学意义(P>0.05);耳穴镇痛组术后2周主动与被动ROM分别为96.50°±3.79°、107.8°±3.37°,对照组分别为93.50°±3.50°、105.27°±3.25°,均有统计学意义(P<0.05);耳穴镇痛组术前HSS评分为(60.23±3.44)分,对照组为(61.70±2.83)分,差异无统计学意义(P>0.05);术后HSS评分分别为(86.97±2.33)、(85.37±2.30)分,差异有统计学意义(P<0.05)。结论膝关节置换术围手术期配合应用耳穴疗法有助于减轻患者的术后疼痛,减少术后总的麻醉剂使用量,有助于患者的早期康复,同时有着费用低、并发症少、操作简单、安全的优点。
