低浓度罗哌卡因髂筋膜间隙阻滞降低全膝关节置换术后反弹痛的研究  

Low concentration ropivacaine reduces rebound pain after iliac fascia compartment block for total knee arthroplasty

作　　者：仲浩 朱江[1] 金伟华[1] 赵凯 金炳荣 佘昶[2] 单冰晨[2] 覃琴[1] Zhong Hao;Zhu Jiang;Jin Weihua;Zhao Kai;Jin Bingrong;She Chang;Shan Bingchen;Qin Qin(Department of Anesthesiology,the Second Affiliated Hospital of Soochow University,Suzhou 215000,China;Department of Orthopedics,the Second Affiliated Hospital of Soochow University,Suzhou 215000,China)

机构地区：[1]苏州大学附属第二医院麻醉科,苏州215000 [2]苏州大学附属第二医院骨科,苏州215000

出　　处：《中华实验外科杂志》2023年第11期2224-2227,共4页Chinese Journal of Experimental Surgery

基　　金：苏州市民生科技医疗卫生应用基础研究(SYS2019074);苏州大学附属第二医院学科建设托举工程(XKTJ-TD202008)。

摘　　要：目的:观察低浓度罗哌卡因髂筋膜阻滞(FICB)对全膝关节置换术(TKA)后反弹痛的影响。方法:择期全麻行单侧TKA患者90例,随机数法将患者分为两组:0.1%罗哌卡因低浓度组(A组)和0.3%罗哌卡因高浓度组(B组),每组45例。两组患者全麻前分别行超声引导40 ml不同浓度罗哌卡因单次FICB。记录术后反弹痛发生率和阻滞消退后NRS评分;术后48 h内补救性镇痛率和阿片药物用量;术后24、48 h静息与运动的NRS评分与肌力评分以及血清IL-6和TNF-α浓度(ELISA法)。正态分布计量资料采用均数±标准差表示,非正态分布计量资料采用中位数(M)和四分位数间距(IQR)表示。结果:术后A组反弹痛发生率低于B组[10.9%(5/45)比53.3%(24/45),χ^(2)=16.986,P<0.01],A组阻滞消退后疼痛程度低于比B组[2.0(1.0~3.5)分比7.0(4.0~7.5)分,Z=-4.110,P<0.01]。术后A组首次按压镇痛泵时间高于比B组[(252.2±80.8)min比(525.6±143.0)min,t=8.324,P<0.01];术后48 h内A组患者镇痛泵有效按压次数低于B组[(11.1±4.4)次比(16.2±6.3)次,t=3.332,P<0.01],A组补救性镇痛率低于B组[4.4%(2/45)比20.0%(9/35),χ^(2)=4.153,P<0.05];术后A组舒芬太尼消耗量低于B组[0~24 h:(18.7±8.0)μg比(32.6±15.5)μg,t=3.981,P<0.01;0~48 h:(33.4±13.1)μg比(48.6±18.8)μg,t=3.310,P<0.01];术后24 h A组的肌力高于B组[1.0(1.0~2.0)分比0(0~1.0)分,Z=-3.528,P<0.01],术后24 h A组运动NRS评分低于B组[(4.6±1.4)分比(7.3±2.2)分,t=7.823,P<0.01]。结论:低浓度罗哌卡因FICB后患者反弹痛发生率低、术后肌力恢复早,更适合TKA后多模式镇痛。Objective To observe effect of low concentration ropivacaine iliac fascial compartment block(FICB)on rebound pain after total knee arthroplasty(TKA).Methods 90 patients undergoing unilateral TKA and general anesthesia were randomly divided into two groups(n=45):0.1%ropivacaine group(group A)and 0.3%ropivacaine group(group B).Randomize based on random numbers generated by SPSS.All patients received ultrasound-guided 40ml 0.1%or 0.3%ropivacaine single-injection FICB before general anesthesia.Incidence of postoperative rebound pain,numerical rating scale(NRS)after block resolution,first press time of postoperative analgesic pump within 48 h,rescue analgesia rate,postoperative opioid consumption,NRS scores for rest and motor at 24 and 48 h,muscle strength scores,and plasma levels of interleukin-6(IL-6)and tumor necrosis factorα(TNF-α)at baseline,24 h and 48 h after operation were recorded.Normal distribution measurement data are represented by mean±standard deviation,while non normal distribution measurement data are represented by median(M)and interquartile interval(IQR).Results The incidence of postoperative rebound pain in Group A was lower than that in Group B[10.9%(5/45)vs.53.3%(24/45),χ^(2)=16.986,P<0.01],the degree of pain in Group A after block resolution was lower than that in Group B[2.0(1.0-3.5)points vs.7.0(4.0-7.5)points,Z=-4.110,P<0.01].The first press analgesia pump time after surgery in Group A was longer than that in Group B[(252.2±80.8)min vs.(525.6±143.0)min,t=8.324,P<0.01];Within 48 hours after surgery,the effective number of compressions with the analgesic pump in Group A was less than that in Group B(11.1±4.4 vs.16.2±6.3,t=3.332,P<0.01),and the rescue analgesia rate in Group A was lower than that in Group B[4.4%(2/45)vs.20.0%(9/35),χ^(2)=4.153,P<0.05];The postoperative consumption of sufentanil in Group A was lower than that in Group B[0-24 hours:(18.7±8.0)μg vs.(32.6±15.5)μg,t=3.981,P<0.01 and 0-48 h:(33.4±13.1)μg vs.(48.6±18.8)μg,t=3.310,P<0.01];The muscle strength of Group A

关 键 词：全膝关节置换术 罗哌卡因 术后镇痛 神经阻滞 反弹痛 

分 类 号：R614[医药卫生—麻醉学]