罗哌卡因股神经导管不同给药方式对术后镇痛的影响  

The effect of two different administration methods of ropivacaine through femoral nerve catheter on postoperative pain relief

作　　者：张伟[1] 朱丰[1] 胡焱[1] 刘雪冰[1] 杨庆国[1] 李世忠[1] 

机构地区：[1]北京积水潭医院麻醉科,100035

出　　处：《临床麻醉学杂志》2012年第1期40-42,共3页Journal of Clinical Anesthesiology

摘　　要：目的探讨罗哌卡因股神经导管不同给药方式用于全膝关节置换术后镇痛的效果。方法拟行全膝关节置换术患者40例,随机均分为持续给药组(A组,0.20%罗哌卡因)和间断给药组(B组,0.33%罗哌卡因)。观察患者术后48h内VAS评分及拔管后24h股神经感觉功能和改良Bromage评分。结果术后24hB组静息和运动时VAS评分均明显低于A组(P<0.05或P<0.01)。术后48hB组运动时VAS评分明显低于A组(P<0.05)。B组罗哌卡因用量明显低于A组(P<0.01)。B组芬太尼用量明显低于A组(P<0.05)。所有患者神经功能恢复均未出现延迟。结论经股神经导管持续或间断给予罗哌卡因均能提供较好的镇痛效果,对股神经功能均没有明显影响;0.33%罗哌卡因间断给药可减少镇痛药用量。Objective To compare the effect of Ropivacaine by two different analgesic methods on pain relief after total knee replacement. Methods Forty patients for total knee replacement were randomly assigned to two groups, continuous group（group A, 0.20% ropivacaine） and intermittent injection group （group B, 0. 33% ropivacaine）. In group A, 0. 20% ropivacaine 5 ml/h was given through femoral nerve catheter, additional 5 ml （lock time 30 rain） as patient controlled bolus. In group B, 0.33% ropivacaine 20 ml was given through the catheter three times a day （q 8 h）] All patients received intravenous fentanyl infusion for supplemental pain controll. Fentanyl was given as 10μg/h and 20μg by bolus if needed. VAS score in postoperative 48 h, sensation function of femoral nerve and Bromage score at 24 h after catheter removed：were noted. Results On postoperation 24 h, VAS at rest or movement in group B is significantly ＇lower than that in group A（P〈0. 05 or P〈 0. 01）. On postoperation 48 h, significant difference was detected between the two groups considering movement VAS（P〈0. 05）. Consumption of total ro.pivahaine in group B is lower than that in group A [（396±0） mg vs （562 ±47） mg, P〈0.01]. Fentanyl consumption in group B were significantly lower than that in group A [（532±34）μg vs （557±44）μg,P〈O, 05]. No nerve function recovery delay was found in all patients. Conclusion The two analgesic methods both provide good postoperative pain control, little impact on nerve function. Analgesic comsumption was reduced by accepting 0. 33% ropivacaine intermittentlw.

关 键 词：全膝关节置换术 股神经导管 多模式镇痛 罗哌卡因 

分 类 号：R614[医药卫生—麻醉学]