全膝关节置换术后股神经阻滞自控镇痛的随机对照研究  

Postoperative Analgesia by Femoral Nerve Block after Total Knee Replacement:Randomized Controlled Trial

作　　者：王宁[1] 戎玉兰[1] 魏越[1] 杨晓霞[1] 李民[1] 郭向阳[1] 

机构地区：[1]北京大学第三医院麻醉科,北京100191

出　　处：《中国微创外科杂志》2011年第4期308-311,共4页Chinese Journal of Minimally Invasive Surgery

摘　　要：目的比较患者自控与恒速输注2种给药方案对全膝关节置换术后患者股神经阻滞镇痛的效果。方法 2010年3月～11月选择60例单侧全膝关节置换术,椎管内麻醉前在超声及神经刺激器引导下置入连续股神经阻滞导管,将阻滞效果完全的患者按随机数字表随机分为2组:恒速输注组(CI组)和患者自控镇痛组(PCA组)。CI组经导管持续输注0.2%罗哌卡因5 ml/h,PCA组输注0.2%罗哌卡因背景量5 ml/h,单次注射5 ml/次,锁定时间60 min。记录2组患者静息痛及运动状态下疼痛评分、满意率以及不良反应发生情况。结果 3例在首次给药后30 min内没有达到完全阻滞而被排除。术后1～3 d静息及主动锻炼时疼痛评分2组无显著性差异(P>0.05)。术后1～3 d被动锻炼时疼痛评分PCA组(4.7±1.3,4.5±1.0,4.5±1.0)显著低于CI组(6.5±1.6,6.1±1.6,5.9±1.6)(P<0.05)。患者满意度PCA组显著高于CI组[8(6～10)vs.7(4～9)](Z=16.957,P=0.031)。2组患者均无耳鸣、口周麻木、眩晕等局麻药中毒症状同,均无因下肢无力而跌倒,无导管脱出。结论与恒速输注相比,患者自控股神经阻滞能够提高术后康复运动时的镇痛效果。ObjectiveTo compare the effects of patient-controlled and continuous-infusion femoral nerve block for postoperative analgesia after total knee replacement（TKR）.MethodsSixty patients who underwent TKR in our hospital between March 2010 and November 2010 in our hospital were enrolled in this study.Before neuraxial block,the patients were scheduled to receive femoral nerve block catheter insertion under the guidance by ultrasonography and nerve stimulation.After confirmation of a successful block,the patients were randomly assigned to continuous infusion group（CI group） and patient controlled analgesia group（PCA group）.0.2% ropivacaine was infused through the femoral catheter,5 ml/h for CI group,and 5 ml/h plus boluses of 5 ml with a lockout time of 60 minutes for PCA group.Pain at rest and during physiotherapy,patients＇ satisfaction and adverse event were recorded.ResultsThree cases were excluded because of incomplete block after first infusion in 30 min.No significant differences between the two groups were noted in the postoperative visual analogue scores（VAS） at rest or during active physiotherapy.The VAS during passive physiotherapy for the first three days after the surgery in PCA group（4.7±1.3,4.5±1.0,4.5±1.0） was lower than those in the CI group（6.5±1.6,6.1±1.6,5.9±1.6;all P0.05）.Patient satisfaction score in PCA group was higher than that in CI group[8（6-10） vs.7（4-9）,Z=16.957,P=0.031].There were no significant differences in side effects between the two groups.ConclusionCompared with continuous infusion technique,patient controlled technique enhances postoperative analgesia by femoral nerve block after TKR.

关 键 词：股神经阻滞 全膝关节置换术 患者自控镇痛 

分 类 号：R614.1[医药卫生—麻醉学]