超声引导下腰丛阻滞联合浸润麻醉用于初次全膝关节置换术后镇痛的效果  

Efficacy of ultrasound-guided continuous lumbar plexus block combined with infiltration anesthesia in patients undergoing primary total knee arthroplasty

作　　者：张洁[1] 肖莉[1] 董补怀[1] 罗振国[1] 

机构地区：[1]西安交通大学医学院附属红会医院麻醉科,西安710054

出　　处：《山西医科大学学报》2017年第11期1191-1194,共4页Journal of Shanxi Medical University

摘　　要：目的评价超声引导下连续腰丛阻滞联合浸润麻醉用于初次全膝关节置换术后镇痛的临床效果。方法本院回顾性分析2016-09~2017-06行初次膝关节置换患者84例,分为连续腰丛阻滞+浸润麻醉组(Ⅰ组,42例)和连续股神经阻滞组(Ⅱ组,42例)。两组患者均在麻醉诱导前用超声引导联合刺激仪定位行神经阻滞穿刺,穿刺成功后留置导管,Ⅰ组患者伤口缝合前于股四头肌肌腱、内外侧副韧带及关节后方注射混合药物。两组患者术后行连续神经阻滞术后镇痛,氟比洛芬酯作为镇痛补救,维持VAS评分<5分。记录术后4,8,12,24,48 h静息VAS评分,记录术后12,24,48 h动态VAS评分及镇痛补救情况。评估术后12,24,48 h患肢股四头肌肌力。观察并记录局麻药中毒及神经损伤等不良反应发生情况。结果术后8,12,24 h静态VAS评分Ⅱ组高于Ⅰ组(P<0.05),术后12 h及24 hⅡ组动态VAS评分高于Ⅰ组(P<0.05),术后12,24 h肌力评分Ⅱ组比Ⅰ组低(P<0.05)。结论超声引导下连续腰丛神经阻滞联合浸润麻醉用于老年初次全膝关节置换术后镇痛效果满意,安全性高。Objective To evaluate the efficacy of ultrasound-guided continuous lumbar plexus block combined with infiltration anesthesia in patients undergoing primary total knee arthroplasty. Methods From September 2016 to June 2017,84 patients with primary total knee arthroplasty were enrolled in this retrospective study. The patients were divided into two groups： continuous lumbar plexus block with infiltration anesthesia group（ group Ⅰ,n = 42） and continuous femoral nerve block group（ groupⅡ,n = 42）. The nerve block catheters were inserted by ultrasound-guide combined with stimulator before induction of general anesthesia in the two groups. In group Ⅰ,50 ml mixture was injected around the quadriceps femoris tendon,the collateral ligaments,the posterior part of the joint capsule before closed. All patients received patient-controlled analgesia（ PCA） after the surgery with 0. 2% ropivacaine background infusion at a rate of 5 ml/h for 48 h. Flurbiprofen axetil was used as a rescue analgesic to maintain the VAS score 5. VAS scores for pain at rest and in movement were recorded at 4,8,12,24,48 h after surgery. The quadriceps strength was measured at 12,24,48 h after surgery. The toxic reaction and adverse effects were recorded. Results Compared with group Ⅰ,VAS score at rest increased at 8,12,24 h after surgery in proup Ⅱ（ P〈0. 05）,VAS score in movement also increased at 12,24 h after surgery（ P〈0. 05）,and the score of muscle strength decreased at 12,24 h after surgery（ P〈0. 05）. Conclusion For the patients with primary total knee arthroplasty,the ultrasound-guided continuous lumbar plexus block with infiltration anesthesia can provide sufficient analgesia with high safety.

关 键 词：超声 神经传导阻滞 局部麻醉 术后疼痛 老年人 全膝关节置换术 

分 类 号：R614[医药卫生—麻醉学]