膝前内侧切口股内侧肌下入路中直视下隐神经阻滞对全膝关节置换术后的镇痛作用  被引量:13

The effect of visualized saphenous nerve block through minimally invasive far medial-subvastus approach on the analgesia after total knee arthroplasty

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作  者:王泽峰 徐杰[1] 罗奋棋[1] 俞国雨 林院[1] Wang Zefeng;Xu Jie;Luo Fenqi;Yu Guoyu;Lin Yuan(Second Department of Orthopedics,Fujian Provincial Hospital,Fujian Medical University,Fuzhou 350001,China)

机构地区:[1]福建省立医院骨二科福建医科大学,福州350001

出  处:《中华医学杂志》2021年第21期1592-1597,共6页National Medical Journal of China

基  金:2019福建省卫生教育联合公关计划项目(2019-WJ-01)。

摘  要:目的:通过分析膝前内侧切口股内侧肌下入路中显露收肌管以远的隐神经的方法,探讨在此处直视下阻滞该神经对全膝关节置换术后的镇痛作用。方法:前瞻性纳入2018年6月至2019年10月至福建省立医院骨二科接受全膝关节置换的膝骨性关节炎患者共100例,其中男29例,女71例,年龄50~87(70±8)岁,所有病例均采用膝前内侧切口股内侧肌下入路。随机数字表法分为直视下隐神经阻滞联合关节周围浸润镇痛组(VSNB+PIA组)和单纯关节周围浸润镇痛组(PIA组)各50例。比较两组术后4、8、12、24、48、72 h静息及活动状态的疼痛视觉模拟评分(VAS)、术后72 h内帕瑞昔布应用率。结果:两组术后静息状态VAS总体差异有统计学意义(F=15.295,P<0.05),其中VSNB+PIA组术后4、8、12、24 h静息状态VAS分别为(1.3±0.8)分、(1.4±0.7)分、(1.7±0.8)分、(3.1±0.8)分,低于PIA组的(1.6±0.9)分、(1.8±0.8)分、(2.3±0.9)分、(3.6±0.8)分(均P<0.05)。两组术后活动状态VAS总体差异有统计学意义(F=18.532,P<0.05),其中VSNB+PIA组术后4、8、12、24 h活动状态VAS分别为(2.0±0.8)分、(2.2±0.7)分、(2.7±0.6)分、(3.7±0.7)分,低于PIA组的(2.3±0.8)分、(2.7±0.7)分、(3.3±0.8)分、(4.4±0.7)分(均P<0.05)。VSNB+PIA组术后72 h内帕瑞昔布应用率为14%(7/50),较PIA组的34%(17/50)减少(P<0.05)。结论:膝前内侧切口的股内侧肌下入路容易显露收肌管以远的隐神经,直视下进行该处隐神经阻滞的联合镇痛方法,比单纯关节周围浸润镇痛法更有效减轻全膝关节置换术后疼痛。Objective To report a method of visualized saphenous nerve block(VSNB)through minimally invasive far medial-subvastus approach distal to the adductor canal in total knee arthroplasty(TKA),and investigate the effect of VSNB in this way on postoperative pain relief.Methods A total of 100 patients with knee osteoarthritis were prospectively included from June 2018 to October 2019,29 males and 71 females,aged 50-87(70±8)years.All patients undergoing TKA through minimally invasive far medial-subvastus approach were randomized to visualized saphenous nerve block combined with periarticular infiltration analgesia group(Group VSNB+PIA)or only periarticular infiltration analgesia group(Group PIA),50 cases in each group.The visual analogue scale(VAS)was used to evaluate the pain degree of patients.Furthermore,the scores of VAS in resting and active state at 4,8,12,24,48,72 hours after operation and the proportion of patients receiving parecoxib within 72 hours after operation were compared between the two groups.Results There was statistically significant difference between the two groups in terms of VAS scores in resting state after surgery(F=15.295,P<0.05).The postoperative VAS scores of Group VSNB+PIA at 4,8,12,24 hours at resting state were 1.3±0.8,1.4±0.7,1.7±0.8,3.1±0.8 respectively,which were all significantly lower than those of Group PIA(1.6±0.9,1.8±0.8,2.3±0.9,3.6±0.8)(P<0.05).The overall difference in terms of VAS scores at active state after surgery was statistically significant between the two groups(F=18.532,P<0.05).The postoperative VAS scores of Group VSNB+PIA at 4,8,12,24 hours at active state were 2.0±0.8,2.2±0.7,2.7±0.6,3.7±0.7 respectively,which were all significantly lower than those of Group PIA(2.3±0.8,2.7±0.7,3.3±0.8,4.4±0.7)(P<0.05).Fourteen percent of patients(7/50)in VSNB+PIA group accepted parecoxib within 72 hours after surgery,which was significantly lower than that in PIA group(34%,17/50)(P<0.05).Conclusions It is easy to expose the saphenous nerve beyond the adductor canal t

关 键 词:全膝关节置换 自主神经传导阻滞 隐神经 股内侧肌下入路 疼痛评分 

分 类 号:R614[医药卫生—麻醉学]

 

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