超声引导下闭孔神经阻滞改善全膝关节置换术后连续股神经阻滞镇痛的效果  

Effect of ultrasound-guided single obturator nerve block on continuous femoral nerve block for postoperative analgesia of patients underwent total knee arthroplasty

作　　者：任晓平[1] 蔡靓羽[1] 张建楠[1] 徐敏逸[1] 

机构地区：[1]南京中医药大学无锡附属医院麻醉科,江苏省214001

出　　处：《江苏医药》2016年第15期1674-1676,共3页Jiangsu Medical Journal

基　　金：江苏省中医药管理局科研项目(LZ13120)

摘　　要：目的观察超声引导下单次闭孔神经阻滞改善连续股神经阻滞用于全膝关节置换(TKA)术后镇痛的效果。方法腰麻-硬膜外联合麻醉下行TKA患者40例,随机均分为连续股神经阻滞镇痛组(A组)和超声引导下单次闭孔神经阻滞联合连续股神经阻滞镇痛组(B组)。连续股神经镇痛药物配方为0.2%罗哌卡因200ml,背景输注量4ml/h,单次追加量4ml,锁定时间30min。术后6、12、24、36和48h,采用VAS疼痛评分评估静息和运动(膝关节被动弯曲30度)疼痛程度;记录术后48h内镇痛相关不良反应。结果与A组比较,B组患者静息和运动VAS疼痛评分均降低,吗啡消耗量和不良反应减少(P<0.05)。结论超声引导下闭孔神经阻滞能改善TKA患者术后连续股神经阻滞镇痛效果。Objective To evaluate the effect of ultrasound-guided single obturator nerve block （ONB） on continuous femoral nerve block（FNB） for postoperative analgesia of patients underwent total knee arthroplasty （TKA）. Methods Forty patients underwent TKA under spinal-epidural anesthesia were equally randomized into two groups of A （undergoing continuous FNB） and B （undergoing continuous FNB plus single ONB）. The analgesic solution for continuous femoral nerve block was 0.2 % ropivacaine 200 ml and analgesic variables were set up as a background infusion of 4 ml/h and a bolus dose of 4 ml in a lockout interval of 30 minutes. VAS pain scores at rest and on movement（with passive mobilization of the knee to a 30 degrees angle） were evaluated at 6,12,24,36 and 48 hours during analgesia. The morphine consumption and analgesia-related adverse effects in postoperative 48 hours were recorded. Results Compared with group A, the VAS scores at rest and on movement were significantly less in group B（P〈0. 05）. So did the morphine consumption and the severity of nausea, vomiting and pruritus. Conclusion Ultrasound-guided single ONE can improve the outcomes of continuous FNB in the patients underwent TKA.

关 键 词：闭孔神经阻滞 股神经阻滞 全膝关节置换术 术后镇痛 

分 类 号：R614[医药卫生—麻醉学]