膝关节单髁置换术中单次与连续收肌管阻滞联合局部浸润麻醉前瞻性对比研究  

A prospective comparative study on effectiveness of single versus continuous adductor canal block combined with local infiltration anesthesia in unicompartmental knee arthroplasty

作　　者：刘典琦 黄文彬 翟文润 李颖芬[2] 陈东峰[1] 郑仕聪 吴颖斌 卢伟杰[1] LIU Dianqi;HUANG Wenbin;ZHAI Wenrun;LI Yingfen;CHEN Dongfeng;ZHENG Shicong;WU Yingbin;LU Weijie(Department of Joint Surgery,the First Affiliated Hospital of Guangzhou Medical University,Guangzhou Guangdong,510120,P.R.China;Department of Anesthesiology,the First Affiliated Hospital of Guangzhou Medical University,Guangzhou Guangdong,510120,P.R.China;Department of Joint Surgery,Foshan Hospital of Traditional Chinese Medicine,Foshan Guangdong,528000,P.R.China)

机构地区：[1]广州医科大学附属第一医院关节外科,广州510120 [2]广州医科大学附属第一医院麻醉科,广州510120 [3]佛山中医院关节外科,广东佛山528000

出　　处：《中国修复重建外科杂志》2024年第4期448-454,共7页Chinese Journal of Reparative and Reconstructive Surgery

摘　　要：目的采用前瞻性对比研究,比较分析膝关节单髁置换术(unicompartmental knee arthroplasty,UKA)术中采用局部浸润麻醉(local infiltration anesthesia,LIA)联合单次收肌管阻滞(single adductor canal block,SACB)或连续收肌管阻滞(continuous adductor canal block,CACB)的早期镇痛效果及对膝关节功能恢复的影响。方法以2022年4月—2023年12月收治的膝关节骨关节炎患者作为研究对象,其中60例符合选择标准纳入研究,按照随机数字表法以1∶1比例分配至SACB组或CACB组。两组患者年龄、性别、身高、体质量、身体质量指数、手术侧别以及术前静息疼痛视觉模拟评分(VAS)、活动VAS评分、牛津大学膝关节评分(OKS)和美国特种外科医院(HSS)评分等基线资料比较,差异均无统计学意义(P>0.05)。两组患者接受LIA联合SACB或CACB多模式镇痛管理。记录并比较两组手术时间、疼痛相关指标(静息以及活动VAS评分,发生突破性疼痛例数及时间,阿片类药物消耗量)、关节功能相关指标(股四头肌肌力、膝关节活动度、OKS评分和HSS评分)以及术后阻滞并发症、不良事件。结果两组手术时间差异无统计学意义(P<0.05)。两组患者术后均获随访,SACB组随访时间为(9.70±4.93)个月、CACB组为(12.23±5.05)个月,差异无统计学意义(P>0.05)。除CACB组术后24 h静息VAS评分低于SACB组,差异有统计学意义(P<0.05)外,其余各时间点两组静息和活动VAS评分比较差异均无统计学意义(P>0.05)。CACB组9例(30.00%)发生突破性疼痛,较SACB组17例(56.67%)减少,发生率差异有统计学意义(P<0.05);但两组突破性疼痛发生时间和阿片类药物消耗量比较,差异均无统计学意义(P>0.05)。SACB组4例、CACB组7例发生不良事件,发生率差异无统计学意义(P>0.05)。CACB组术后1、2 d膝关节活动度优于SACB组(P<0.05);两组术后0 d膝关节活动度以及各时间点股四头肌肌力、OKS评分、HSS评分比较,差异均无统计学Objective To compare the early analgesic effects and the impact on knee joint function recovery after unicompartmental knee arthroplasty(UKA)between single adductor canal block(SACB)and continuous adductor canal block(CACB)combined with local infiltration anesthesia(LIA)using a prospective study.Methods The patients with knee osteoarthritis admitted between April 2022 and December 2023 were enrolled as a subject.Among them,60 patients met the selection criteria and were enrolled in the study.They were randomly assigned to the SACB group or CACB group in a ratio of 1:1 using a random number table method.There was no significant difference between the two groups(P>0.05)in terms of age,gender,height,body mass,body mass index,affected side,and preoperative resting visual analogue scale(VAS)score and active VAS score,Oxford knee score(OKS),and American Hospital of Special Surgery(HSS)score.All patients received multimodal analgesia management using LIA combined with SACB or CACB.The operation time,pain related indicators(resting and activity VAS scores,number and timing of breakthrough pain,opioid consumption),joint function related indicators(quadriceps muscle strength,knee range of motion,OKS score,and HSS score),as well as postoperative block complications and adverse events were recorded and compared between the two groups.Results There was no significant difference in the operation time between the two groups(P<0.05).All patients in the two groups were followed up with a follow-up time of(9.70±4.93)months in the SACB group and(12.23±5.05)months in the CACB group,and the difference was not significant(P>0.05).The CACB group had a significant lower resting VAS score at 24 hours after operation compared to the SACB group(P<0.05).There was no significant difference in resting and active VAS scores between the two groups at other time points(P>0.05).The CACB group had a significantly lower incidence of breakthrough pain compared to the SACB group[9 cases(30.00%)vs.17 cases(56.67%);P<0.05).However,there was no signif

关 键 词：单次收肌管阻滞 连续收肌管阻滞 局部浸润麻醉 膝关节单髁置换术 镇痛 关节功能 

分 类 号：R614[医药卫生—麻醉学]