单次股神经联合坐骨神经阻滞与术中关节腔周围鸡尾酒注射镇痛在全膝关节置换术后镇痛效果比较  

Comparison of The Efficacy of Two Analgesic Methods After Total Knee Arthroplasty

作　　者：赵俊旭[1] 孙荣鑫[1] 雷鹏飞[2] 巨啸晨[1] 姜侃[1] 

机构地区：[1]新疆医科大学第六附属医院,新疆乌鲁木齐830000 [2]中南大学湘雅医院骨科,湖南长沙410008

出　　处：《医学临床研究》2016年第3期513-515,518,共4页Journal of Clinical Research

摘　　要：【目的】探讨单次股神经联合坐骨神经阻滞与术中关节腔周围鸡尾酒注射镇痛在全膝关节置换（total knee arthroplasty，TKA）术后镇痛效果。【方法】选择因单侧膝关节骨性关节炎行TKA且ASAⅠ～Ⅱ级的患者70例，按数字法随机分为两组，每组35例，术后单次股神经联合坐骨神经阻滞为A组、术中关节腔周围鸡尾酒注射镇痛为B组。两组手术麻醉方式均采用腰麻联合硬膜外麻醉方法，术后采用视觉模拟（VAS）评分法评估患者疼痛程度、患肢肌力；记录术后额外镇痛药物氯诺昔康总用量和镇痛相关并发症等；在术后2周、1个月、3个月、6个月的随访中，依照膝关节学会评分系统（KSS）对两组患者膝关节功能进行评估比较。【结果】在术后4h、6h、12h、24h、36h、48h静息状态VAS疼痛评分A组均显著低于B组（P〈0．05）；术后24h、36h、48h进行膝关节持续被动活动（CPM）时累计氯诺昔康镇痛药用量A组均较B组低（P〈0．05）；A组术后尿潴留、皮肤瘙瘁、恶心呕吐等不良反应也均显著低于B组（P〈0．05）；两组术后2周、1个月、3个月、6个月患膝膝关节功能评估比较差异无统计学意义（P〉0．05）。【结论】单次股神经联合坐骨神经阻滞在TKA术后镇痛优于术中关节腔周围鸡尾酒注射镇痛，不良并发症低于术中关节腔周围鸡尾酒镇痛。单次股神经联合坐骨神经阻滞为TKA术后镇痛安全、有效的方法。[Objective]To compare the analgesic efficacy of single shot injection of femoral plus sciatic nerve block with periarticular cocktail drug injection analgesia after total knee replacement and evaluate the knee function through follow-ups after two-weeks, one-month, three-months, and six-months postoperatively . [Methods]Seventy patients undergoing unilateral total knee replacement were randomly into two groups, with 35 cases each（ n = 35）. Using even and odd numbers, the patients were divided into Group A and Group B. Patients in Group A were given single shot injection of femoral plus sciatic nerve block for postoperative analgesia and Group B was given periarticular cocktail drug injection analgesia. All patients received the same spinal anesthesia combined with epidural anesthesia. In the postoperative period, the Visual Analogue Scale （VAS） was used to evaluate the postoperative pain scores in the two groups. The total amount of lornoxicam, muscle strength of limbs, and analgesic associated complications were observed and recorded. All patients were followed up after two weeks, one month, three months, and six months, using Knee Society scoring system （KSS） to evaluate knee function. [Results]After 4h. 6h, 12h. 24h. 36h.48h postoperative resting state, pain scores （VAS） in Group A was significantly lower than Group B （ P 〈0.05）. During the continuous passive movement （CPM） of knee postoperatively at 24 and 48 hours, the dosage of lornoxicam in Group A was significantly lower than that in Group B （ P 〈0.05）. Adverse reactions in Group A such as pruritus, nausea, vomiting, and so on were also fewer than Group B （ P 〈0.05）. No significant differences were found in knee function evaluation of two groups after follow-ups performed after two Weeks, one month, three months, and six months （ P 〉0.05）. [Conclusion]Single shot injection of femoral plus sciatic nerve block has a superior analgesic effect to periarticular cocktail drug injection analgesia after total knee repla

关 键 词：股神经 坐骨神经 神经传导阻滞 镇痛 膝关节 人工 

分 类 号：R684.76[医药卫生—骨科学]