收肌管阻滞与单次坐骨神经阻滞联合药物镇痛对全膝关节置换后疼痛的影响  

Effect of adductor canal block and single sciatic nerve block combined with analgesic drugs on pain after total knee arthroplasty

作　　者：耿浩洋 刘文平 王国瑞 刘彬 王伟 马占桥[1] 王建华 Geng Haoyang;Liu Wenping;Wang Guorui;Liu Bin;Wang Wei;Ma Zhanqiao;Wang Jianhua(Department of Anesthesiology,Hebei Province Cangzhou Hospital of Integrated Traditional and Western Medicine,Cangzhou 061000,Hebei Province,China;Department of Orthopedics,Zhengding County People’s Hospital,Shijiazhuang 050899,Hebei Province,China)

机构地区：[1]河北省沧州中西医结合医院麻醉科,河北省沧州市061000 [2]河北省正定县人民医院骨科,河北省石家庄市050899

出　　处：《中国组织工程研究》2024年第24期3833-3838,共6页Chinese Journal of Tissue Engineering Research

基　　金：河北省2022年度医学科学研究课题计划(20220689),项目负责人:刘文平。

摘　　要：背景:全膝关节置换术是治疗晚期骨关节炎的有效手段,但术后疼痛和关节功能恢复是主要的挑战。神经阻滞和混合药物注射是两种常用的镇痛方法,但其联合应用的效果尚不明确。目的:探讨在全膝关节置换过程中应用超声引导下连续性收肌管阻滞+单次坐骨神经阻滞+“鸡尾酒”混合药物镇痛对患者置换后疼痛缓解以及关节功能恢复的影响。方法:纳入于2022年1-5月河北省沧州中西医结合医院收治的骨关节炎患者120例,随机分为2组(n=60),观察组采用超声引导下连续性收肌管阻滞+单次坐骨神经阻滞+“鸡尾酒”混合药物镇痛,对照组采用超声引导下连续性收肌管阻滞+单次坐骨神经阻滞。比较两组患者在目测类比评分、特种外科医院关节功能评分、疼痛递质、炎症因子表达水平、不良反应发生以及术后徒手肌力方面的差异。结果与结论:①观察组患者在术后6,8,12,24,48,72 h时的静息、运动状态下目测类比评分均低于对照组(P<0.05);②观察组患者在术后1,3个月时的特种外科医院评分显著高于对照组(P<0.05);③在疼痛递质以及炎症因子方面,观察组患者的表达水平要显著低于对照组(P<0.05);④在不良反应以及术后徒手肌力方面,两组之间差异无显著性意义(P>0.05);⑤提示在全膝关节置换过程中应用超声引导连续性收肌管阻滞和单次坐骨神经阻滞的同时,采用“鸡尾酒”混合镇痛药物关节腔注射的方式可以起到很好的镇痛效果,更利于关节功能的恢复,也能缓解术后疼痛以及炎症,同时还具有较高的安全性。BACKGROUND:Total knee arthroplasty is an effective treatment for late-stage osteoarthritis,but postoperative pain and joint function recovery are the main challenges.Nerve block and mixed drug injection are two common pain relief methods,but the effect of their combined use is still unclear.OBJECTIVE:To investigate the effects of ultrasound-guided continuous adductor canal block+single sciatic nerve block+“cocktail”mixed drug analgesia on postoperative pain relief and joint function recovery in total knee arthroplasty.METHODS:120 patients with osteoarthritis admitted to Hebei Province Cangzhou Hospital of Integrated Traditional and Western Medicine from January to May 2022 were randomly divided into two groups(n=60).The observation group received ultrasound-guided continuous adductor canal block+single sciatic nerve block+”cocktail”mixed drug analgesia.The control group received ultrasound-guided continuous adductor canal block+single sciatic nerve block.The differences in visual analog scale score,hospital for special surgery score,pain mediators,expression levels of inflammatory factors,the occurrence of adverse reactions,and postoperative barehanded muscle strength test were compared between the two groups.RESULTS AND CONCLUSION:(1)The visual analog scale scores at rest and exercise were lower in the observation group than those in the control group at 6,8,12,24,48,and 72 hours postoperatively(P<0.05).(2)Hospital for special surgery scores at 1 and 3 months postoperatively were significantly higher in the observation group than those in the control group(P<0.05).(3)In terms of pain mediators and inflammatory factors,the expression levels were significantly lower in the observation group than those in the control group(P<0.05).(4)There was no statistically significant difference in terms of adverse effects and postoperative barehanded muscle strength examination between the two groups(P>0.05).(5)In total knee arthroplasty,ultrasound-guided continuous adductor canal block and single sciatic nerve block,t

关 键 词：连续收肌管阻滞 单次坐骨神经阻滞 全膝关节置换 混合式药物 疼痛 

分 类 号：R459.9[医药卫生—治疗学] R318[医药卫生—临床医学] R687.4