超声引导下连续收肌管阻滞联合坐骨神经阻滞在老年膝关节置换术后镇痛的效果  

Effect of ultrasound-guided continuous adductor canal block combined with sciatic nerve block for postoperative analgesia in elderly patients undergoing total knee arthroplasty

作　　者：黎阳 刘金凤 李春莲 梁月影 王晨[1] 任蕾 于大勇[2] LI Yang;LIU Jinfeng;LI Chunlian;LIANG Yueying;WANG Chen;REN Lei;YU Dayong(Department of Anesthesiology, Tian jin Third Central Hospital Branch, Tianjin 300250, China)

机构地区：[1]天津市第三中心医院分院麻醉科,300250 [2]天津市人民医院麻醉科

出　　处：《临床麻醉学杂志》2019年第9期846-849,共4页Journal of Clinical Anesthesiology

摘　　要：目的评价超声引导下连续收肌管阻滞联合连续坐骨神经阻滞用于老年患者全膝关节置换术后镇痛的效果。方法择期全麻下行单侧全膝关节置换术患者80例,男46例,女34例,年龄65~80岁,体重55~82 kg,ASAⅠ-Ⅱ级,采用随机数字表法分为两组,连续收肌管阻滞组(A组)和连续收肌管阻滞联合连续坐骨神经阻滞组(B组),每组40例。手术结束后两组在超声引导下行收肌管阻滞,然后B组在超声引导下行坐骨神经阻滞,两组分别注入负荷剂量0.2%罗哌卡因20 ml后,置入神经丛导管,连接PCA泵。记录术后4、8、12、24、48 h的静息和活动VAS疼痛评分,镇痛泵有效按压次数,补救镇痛,改良Bromage运动阻滞分级,以及神经阻滞相关并发症等。结果与A组比较,B组术后4~24 h的静息VAS评分,4~48 h的活动VAS评分均明显降低,术后48 h内镇痛泵有效按压次数和补救镇痛明显减少(P<0.05)。术后24 h两组改良Bromage运动阻滞分级均恢复到0级。两组均未见神经阻滞相关并发症。结论连续收肌管阻滞联合连续坐骨神经阻滞用于老年患者全膝关节置换术后镇痛的效果优于单纯连续收肌管阻滞。Objective To evaluate the efficacy of ultrasound-guided continuous adductor canal block combined with sciatic nerve block for postoperative analgesia in elderly patients undergoing total knee arthroplasty. Methods Eighty patients aged 65-80 year, weighing 55-82 kg, falling into ASA physical status Ⅰ-Ⅱ, scheduled for elective unilateral total knee arthroplasty, were divided into 2 groups(n = 40 each) using a random numbler table: continuous adductor canal block group(group A) and continuous adductor canal block combined with sciatic nerve block group(group B). All patients underwent general anesthesia with tracheal intubation. After the operation, adductor canal block was performed under ultrasound guidance, and 0.2% ropivacaine 20 ml was injected in the two groups, and in addition sciatic nerve block was then performed under ultrasound guidance, and 0.2% ropivacaine 20 ml was injected in group B. Static and active VAS pain scores were recorded at 4, 8, 12, 24, and 48 h after surgery. The number of effective compressions of analgesic pump, the analgesia rescue rate, the classification of Bromage exercise block, the complications associated with nerve block, and the occurrence of adverse reactions such as nausea, vomiting were all recorded. Results Compared with group A, the static VAS scores of 4-24 hours after operation, and the active VAS scores of 4-48 hours were decreased significantly in group B(P < 0.05). The effective compression times and the remedial analgesia rate of analgesic pumps were decreased at 48 hours after operation(P < 0.05). There were no complications related to nerve block, and there was no significant difference in the incidence of modified Bromage block and postoperative nausea and vomiting between the two groups. Conclusion Ultrasound-guided continuous adductor canal block combined with sciatic nerve block produces better efficacy than either one used alone for postoperative analgesia in the elderly patients undergoing total knee arthroplasty.

关 键 词：膝关节置换术 神经阻滞 收肌管 坐骨神经 

分 类 号：R614[医药卫生—麻醉学]