复方倍他米松加入罗哌卡因收肌管阻滞用于膝关节置换术后镇痛的效果  

Effect of compound betamethasone combined with ropivacaine adductor canal block on analgesia after knee replacement

作　　者：张欢楷[1] 黄小贤[1] 张隆盛[1] 杨铎 李冰[1] 黄熙扬 林耿彬[1] 黄志良[1] ZHANG Huan-kai;HUANG Xiao-xian;ZHANG Long-sheng;YANG Duo;LI Bing;HUANG Xi-yang;LIN Geng-bin;HUANG Zhi-liang(Jieyang People's Hospital,Jieyang 522000,China)

机构地区：[1]揭阳市人民医院,广东揭阳522000

出　　处：《黑龙江医药科学》2021年第6期132-134,137,共4页Heilongjiang Medicine and Pharmacy

基　　金：揭阳市医疗卫生科技创新项目,编号:YLWS025;广东省医学科学技术研究基金,编号:B2018001、A2021400。

摘　　要：目的:探讨复方倍他米松加入罗哌卡因收肌管阻滞用于膝关节置换术后镇痛的效果。方法:选择2018-05~2021-05在揭阳市人民医院择期行膝关节置换手术患者66例,随机分为B组和R组,每组33例。两组患者均采用腰硬联合麻醉,术后两组患者均进行超声引导收肌管阻滞,B组使用复方倍他米松0.5mL+1%罗哌卡因3mL+生理盐水16.5mL稀释至20mL,R组使用1%罗哌卡因3mL+生理盐水17mL稀释至20mL,阻滞完成后连接静脉镇痛泵。记录两组患者术后2h、4h、8h、12h、24h、48h的静息和运动疼痛VAS评分;记录两组患者术后首次下床活动时间、术后48h下床活动总次数、镇痛满意度;记录两组患者使用氟比洛芬酯、舒芬太尼补救镇痛例数;记录两组患者多模式镇痛期间不良反应发生情况。结果:B组患者术后12h、术后24h静息和运动疼痛VAS评分明显低于R组患者(P<0.05),B组患者术后48h下床活动总次数、镇痛满意度明显高于R组患者(P<0.05),B组患者使用氟比洛芬酯补救镇痛例数明显低于R组患者(P<0.05),两组患者镇痛期间均未发生任何不良反应,包括穿刺部位感染、血肿、恶心呕吐、低血压、眩晕等。结论:复方倍他米松加入罗哌卡因收肌管阻滞能有效缓解膝关节置换术后疼痛,延长术后镇痛时间,促进患者下床活动,减少患者术后镇痛药使用,提高镇痛满意度,效果优于单独罗哌卡因收肌管阻滞。Objective:To investigate the effect of compound betamethasone combined with ropivacaine adductor canal block on analgesia after knee replacement.Methods:Sixty-six patients undergoing elective knee replacement surgery in Jieyang People's Hospital from May 2018 to May 2021 were selected and randomly divided into group B and group R,with 33 patients in each group.Patients in both groups received combined lumbar epidural anesthesia.After surgery,patients in both groups received ultrason-guided adductor canal block.Group B was diluted to 20mL with compound betamethasone 0.5 mL+1%ropivacaine 3mL+normal saline 16.5mL,and group R was diluted to 20 mL with 1%ropivacaine 3 mL+normal saline 17 mL.The intravenous analgesic pump was connected after the block was completed.VAS scores of resting and exercise pain at 2,4,8,12,24 and 48 h after surgery were recorded in two groups.The time of first postoperative ambulation,total number of ambulation and analgesia satisfaction were recorded.The number of patients in the two groups using flurbiprofen ester and sufentanil for relief analgesia was recorded.The incidence of adverse reactions during multi-mode analgesia in two groups was recorded.Results:VAS scores of patients in group B were significantly lower than those in group R at 12 and 24 hours after operation(P<0.05).The total number of out of bed activity and analgesic satisfaction 48 hours after operation in group B were significantly higher than that in group R(P<0.05).The number of patients in group B using flurbiprofen ester for remedial analgesia was significantly lower than that in group R.The differences were statistically significant(P<0.05).No adverse reactions such as puncture site infection,hematoma,nausea and vomiting,hypotension and dizziness occurred in two groups during analgesia.Conclusion:Compound betamethasone combined with ropivacaine adductor tube block can effectively relieve pain after knee replacement,prolong postoperative analgesia time,promote patients'activity to get out of bed,reduce postoperative an

关 键 词：复方倍他米松 罗哌卡因 收肌管阻滞 膝关节置换手术 术后镇痛 

分 类 号：R687.4[医药卫生—骨科学]