腰丛置管分次给局麻药用于全膝关节置换术术后镇痛  

Multiple-injections lumbar plexus block controlled analgesia after unilateral total knee replacement

作　　者：韩晓东[1,2] 张学政[2] 倪建武 王权光[2] 陈丽梅[2] 张裕坚[2] Chenggang Hu 徐旭仲[2] 

机构地区：[1]温州市中心医院麻醉科,浙江温州325000 [2]温州医学院附属第一医院麻醉科,浙江温州325000 [3]温州市第八人民医院麻醉科,浙江温州325000 [4]美国加利福尼亚Palomar医学中心麻醉科

出　　处：《温州医学院学报》2012年第6期526-529,共4页Journal of Wenzhou Medical College

基　　金：温州市科技局对外合作项目(H20090013)

摘　　要：目的:观察腰丛置管分次给药用于单侧全膝关节置换手术术后镇痛的临床效果。方法:择期行单侧全膝关节置换手术患者30例,随机分为腰丛镇痛组(腰丛组)和静脉镇痛组(静脉组),每组15例。2组均在腰丛联合坐骨神经阻滞下完成手术,腰丛组在腰丛留置导管术毕经导管分次注射局麻药镇痛;静脉组患者术后行自控静脉吗啡镇痛。记录2组患者术后2、4、8、12、24和48 h的疼痛强度、镇静评分。记录2组患者术后进食情况,术后48 h内出现的呕吐、瘙痒和尿潴留发生的例数。结果:2组患者在术后各时间点的静息VAS评分差异无统计学意义,但腰丛组术后12、24和48 h的运动VAS评分显著低于静脉组(P<0.01)。静脉组术后8和12 h镇静评分低于腰丛组。腰丛组瘙痒、尿潴留和食欲抑制的发生率低于静脉组(P<0.05)。结论:腰丛置管分次给药镇痛全膝关节置换手术术后镇痛效果确切,不良反应少,有利于术后恢复。Objective： To compare the clinical outcomes of multiple-injections lumbar plexus block （LPB） with that of intravenous patient-controlled analgesia （PCIA） after unilat-eral total knee replacement （TKR）. Methods： Thirty patients scheduled for TKR were randomly devided into two groups. The surgery was completed in all patients under combined lumbar plexus and sciatic nerve block. In group L, the multiple-injections LPB was used for postoperative analgesia, and in group V, the PCIA was used. The visual analogue scales （VAS） and sedation scores at the time of 2, 4, 8, 12, 24, 48 h postoperatively were recorded. The time to first foodintake after surgery and the side effects （vomiting,pruritus and urinary retention） during 48 h postoperatively were also noted. Results： Compared with Group V, Group L reduced the VAS scores on movement at 12, 24 and 48 h postoperatively （P〈0.01）. The sedation scores at 8 and 12 h postoperatively in group V were lower than that in group L （P〈0.01）. The incidences of pruritus and urinary retention in Group Y were higher than that in group L（P〈0.05）, and the time to first foodintake after surgery in group L was shorter than that in group V（P〈0.05）. Conclusion： Multiple-injections lumbar plexus block provides excellent postoperative anal- gesia for patients after unilateral total knee replacement, with less side effects and better recovery after surgery when compared with intravenous patient-controlled analgesia.

关 键 词：腰丛 神经阻滞 全膝关节置换术 术后镇痛 

分 类 号：R614.4[医药卫生—麻醉学]