不同容量收肌管阻滞用于全膝关节置换术的镇痛效果  

ANALGESIC EFFECT OF ADDUCTOR CANAL BLOCK WITH DIFFERENT VOLUMES IN TOTAL KNEE ARTHROPLASTY

作　　者：吴秀云[1] 袁新 李少娜 王士雷[1] 王春花[1] 李瑜[1] WU Xiuyun;YUAN Xin;LI Shaona;WANG Shilei;WANG Chunhua;LI Yu(Department of Anesthesiology,Affiliated Hospital of Qingdao University,Qingdao 266000,China)

机构地区：[1]青岛大学附属医院麻醉科,山东青岛266000 [2]济宁市第二人民医院麻醉科

出　　处：《青岛大学学报（医学版）》2022年第5期672-676,共5页Journal of Qingdao University(Medical Sciences)

基　　金：国家自然科学基金青年项目(81702172)。

摘　　要：目的比较超声引导下不同容量收肌管阻滞用于全膝关节置换术的镇痛效果。方法将拟行全膝关节置换的60例病人随机分为2组,每组30例。麻醉开始前在超声引导下A组和B组病人分别用3.75 g/L的罗哌卡因20、30 mL进行收肌管阻滞。分别记录两组病人术后不同时间的静息和运动时视觉模拟评分法(VAS)评分、膝关节功能恢复情况以及吗啡当量、并发症、病人满意度、术后住院时间等指标。结果除术后72 h被动运动VAS评分外,不同状态下A组病人的VAS评分均高于B组,差异有统计学意义(F=5.07~64.47,P<0.05)。A组病人术后消耗吗啡当量高于B组病人,差异有统计学意义(t=11.66,P<0.05)。A组病人术后12、24、48 h的膝关节弯曲度显著低于B组(F=5.26~7.04,P<0.05),术后24、48 h的股四头肌肌力显著低于B组(F=28.14、31.57,P<0.05),术后72 h的步行距离显著短于B组(F=7.44,P<0.05)。两组病人满意度、夜间睡眠情况、术后并发症发生情况差异均有统计学意义(χ2=4.26~29.40,P<0.05)。结论20和30 mL罗哌卡因收肌管阻滞均能减轻病人的术后疼痛,但30 mL容量收肌管阻滞能提供更完善的镇痛,有利于膝关节功能的早期恢复。Objective To investigate the analgesic effect of ultrasound-guided adductor canal block with different volumes in total knee arthroplasty.Methods A total of 60 patients who planned to undergo total knee arthroplasty were randomly divi-ded into groups A and B,with 30 patients in each group.Before anesthesia,the patients in groups A and B were given 3.75 g/L ropivacaine at a volume of 20 mL and 30 mL,respectively,for ultrasound-guided adductor canal block.Related indices were recorded for both groups at different time points after surgery,including Visual Analogue Scale(VAS)score at rest and after exercise,knee function recovery,morphine equivalent,complications,patients’degree of satisfaction,and length of postoperative hospital stay.Results Compared with group B,group A had significantly higher VAS scores under different states except the VAS score of passive exercise at 72 h after surgery(F=5.07-64.47,P<0.05).Group A had a significantly higher postoperative morphine equivalent consumption than group B(t=11.66,P<0.05).Compared with group B,group A had a significantly lower degree of knee joint flexion at 12,24,and 48 h after surgery(F=5.26-7.04,P<0.05),a significantly lower muscle strength of quadriceps femoris at 24 and 48 h after surgery(F=28.14,31.57;P<0.05),and a significantly shorter walking distance at 72 h after surgery(F=7.44,P<0.05).There were significant differences in patients’degree of satisfaction,nighttime sleep,and postoperative complications between the two groups(χ2=4.26-29.40,P<0.05).Conclusion Adductor canal block with 20 mL or 30 mL ropivacaine can alleviate postoperative pain,but adductor canal block with 30 mL ropivacaine can provide better analgesia and thus help with the early recovery of knee function.

关 键 词：神经传导阻滞 关节成形术 置换 膝 肌纤维 骨骼 镇痛 

分 类 号：R614.4[医药卫生—麻醉学] R687.42[医药卫生—外科学]