超声引导不同浓度罗哌卡因坐骨神经复合股神经阻滞对膝关节置换术后的镇痛效果  

ANALGESIC EFFECT OF ULTRASOUND-GUIDED SCIATIC-FEMORAL NERVE BLOCK WITH DIFFERENT CONCENTRATIONS OF ROPIVACAINE AFTER TOTAL KNEE ARTHROPLASTY

作　　者：嵇湘林 马晓军[1] 殷积慧[1] 黄辉[1] 刘英志[1] 姜爱华[1] JI Xianglin;MA Xiaojun;YIN Jihui;HUANG Hui;LIU Yingzhi;JIANG Aihua(Department of Anesthesiology, The Affiliated Hospital of Qingdao University, Qingdao 266003, Chin)

机构地区：[1]青岛大学附属医院麻醉科,山东青岛266003

出　　处：《青岛大学学报（医学版）》2018年第2期193-196,共4页Journal of Qingdao University(Medical Sciences)

摘　　要：目的观察超声引导不同浓度罗哌卡因坐骨神经复合股神经阻滞对全膝关节置换术后的镇痛效果。方法选择行择期单侧膝关节置换手术病人90例,随机分为Q组、W组和E组,每组30例。术前各组用不同浓度(Q组3.50g/L,W组3.75g/L,E组4.00g/L)的罗哌卡因20mL行坐骨神经阻滞,4.00g/L罗哌卡因20mL行股神经阻滞。术中观察病人平均动脉压及心率,术后用视觉模拟评分法(VAS)评估病人疼痛状况,用HSS评分评估病人下肢肌力恢复情况,记录肌力恢复时间(T)。结果 3组病人术中平均动脉压、心率比较差异无显著性(P>0.05),术后运动功能恢复时间和VAS评分差异有显著性(F=19.65~601.20,P<0.05)。Q组病人术后疼痛评分较高(VAS评分≥4分),肌力恢复较快(T≤24h);W组术后镇痛效果可(VAS评分≤4分),肌力阻滞时间较适中(T≤24h);E组镇痛效果可(VAS评分≤4分),但是肌力阻滞时间较Q组和W组长(T≥24h)。结论 3.75g/L罗哌卡因坐骨神经复合股神经阻滞用于膝关节置换手术,镇痛效果满意,且术后对运动神经阻滞影响较小。Objective To investigate the analgesic effect of ultrasound-guided sciatic-femoral nerve block with different concentrations of ropivacaine after total knee arthroplasty（TKA）. Methods A total of 90 patients who underwent selective unilateral TKA were randomly divided into group Q,group W,and group E,with 30 patients in each group.The patients were treated with 20 mL ropivacaine at different concentrations（3.50 g/L for group Q,3.75 g/L for group W,and 4.00 g/L for group E）for sciatic nerve block and 20 mL ropivacaine at a concentration of 4.00 g/L for femoral nerve block before surgery.Mean arterial pressure and heart rate were observed during surgery;the Visual Analogue Scale（VAS）scale was used to evaluate pain;the Hospital for Special Surgery（HSS）knee-rating score was used to assess the recovery of muscle strength of the lower limbs,and the time to such recovery（T）was recorded. Results There were no significant differences in heart rate and mean arterial pressure between the three groups during surgery（P〉0.05）,and after surgery,there were significant differences in the time to motor function recovery and VAS score between the three groups（F=19.65-601.20,P〈0.05）.Group Q had a higher postoperative pain score（VAS score≥4）and a shorter time to the recovery of muscle strength（T≤24 h）than the other two groups.Group W had a good postoperative analgesic outcome（VAS score≤4）and a moderate time of muscular block（T≤24 h）.Group E had a good analgesic outcome（VAS score≤4）and a longer time of muscular block（T≥24 h）than the other two groups. Conclusion Sciatic-femoral nerve block using 3.75 g/L ropivacaine has a satisfactory analgesic effect in TKA,with little impact on motor nerve block after surgery.

关 键 词：罗哌卡因 关节成形术 置换 膝 坐骨神经 股神经 神经传导阻滞 镇痛 

分 类 号：R614[医药卫生—麻醉学]