超声引导布比卡因脂质体收肌管阻滞用于老年患者全膝关节置换术镇痛的效果  

Effect of ultrasound-guided adductor canal block with bupivacaine liposome on analgesia in elderly patients undergoing total knee arthroplasty

作　　者：樊超[1] 周俊辉[2] 孙全鹏 张永杰[4] 全立新[1] 梅伟[5] 高俊伟[1] 白伟杰 薄文杰 徐璐丹 Fan Chao;Zhou Junhui;Sun Quanpeng;Zhang Yongjie;Quan Lixin;Mei Wei;Gao Junwei;Bai Weijie;Bo Wenjie;Xu Ludan(Department of Anesthesiology,Zhengzhou Orthopaedic Hospital,Zhengzhou 450052,China;Department of Anesthesiology,Henan Provincial Chest Hospital,Chest Hospital of Zhengzhou University,Zhengzhou 450003,China;Department of Anesthesiology and Perioperative Medicine,The First Affiliated Hospital of Zhengzhou University,Zhengzhou 450044,China;Department of Anesthesiology,The First Affiliated Hospital of Henan University of Science and Technology,Luoyang 471000,China;Department of Orthopedics,Zhengzhou Orthopaedic Hospital,Zhengzhou 450052,China)

机构地区：[1]郑州市骨科医院麻醉科,郑州450052 [2]河南省胸科医院&郑州大学附属胸科医院麻醉科,郑州450003 [3]郑州大学第一附属医院麻醉与围术期医学科,郑州450044 [4]河南科技大学第一附属医院麻醉科,洛阳471000 [5]郑州市骨科医院骨科,郑州450052

出　　处：《中华麻醉学杂志》2024年第7期816-820,共5页Chinese Journal of Anesthesiology

基　　金：河南省科技攻关项目(LHGJ20200758);中国初级卫生保健基金会"爱医研,爱无限"临床科研公益项目(YYWX202410004ZZ)。

摘　　要：目的评价超声引导布比卡因脂质体收肌管阻滞用于老年患者全膝关节置换术后镇痛的效果。方法本研究为前瞻性研究。选择2023年4月至2024年1月郑州市骨科医院择期蛛网膜下腔麻醉下行单侧全膝关节置换术患者60例,性别不限,年龄65~83岁,体质量50~80 kg,ASA分级Ⅱ或Ⅲ级,采用随机数字表法分为2组(n=30):布比卡因脂质体组(LB组)和罗哌卡因组(R组)。于蛛网膜下腔麻醉前30 min,在超声引导下行收肌管神经阻滞,LB组注射布比卡因脂质体稀释液20 ml(133 mg),R组注射0.5%罗哌卡因20 ml。术后行PCIA,VAS评分≥3分时,采用曲马多进行补救镇痛。分别于术后8、12、24、48和72 h时记录静态和动态VAS评分。记录术后首次按压镇痛泵时间和术后72 h内补救镇痛情况;分别于术前1 d和术后12、24、48、72 h时测定股四头肌肌力;分别于术前1 d和术后24、48、72 h时测定膝关节活动度。术后72 h时记录患者镇痛满意度评分;记录术后72 h内不良反应发生情况。结果与R组比较,LB组术后12、24、48和72 h时静态和动态VAS评分降低,首次按压镇痛泵时间延长,术后补救镇痛率降低,镇痛满意度评分升高,膝关节活动度增加(P<0.05),股四头肌肌力和不良反应发生率差异无统计学意义(P>0.05)。结论超声引导布比卡因脂质体收肌管阻滞用于老年患者全膝关节置换术的镇痛效果优于罗哌卡因。Objective To evaluate the effect of ultrasound-guided adductor canal block with bupivacaine liposome on analgesia in elderly patients undergoing total knee arthroplasty.Methods This was a prospective study.Sixty American Society of Anesthesiologists Physical Status classificationⅡorⅢpatients,regardless of gender,aged 65-83 yr,weighing 50-80 kg,scheduled for elective unilateral total knee arthroplasty under subarachnoid anesthesia from April 2023 to January 2024 in Zhengzhou Orthopaedic Hospital,were divided into 2 groups(n=30 each)using a random number table method:bupivacaine liposome group(LB group)and ropivacaine group(R group).Ultrasound-guided adductor canal block was performed at 30 min before subarachnoid anesthesia,bupivacaine liposome diluent 20 ml(133 mg)was injected in LB group,and 0.5%ropivacaine 20 ml was injected in R group.Patient-controlled intravenous analgesia was performed after operation,and tramadol was used for rescue analgesia when the visual analogue scale(VAS)score≥3.VAS scores at rest and during activity were recorded at 8,12,24,48 and 72 h after surgery.The time to the first pressing analgesia pump and rescue analgesia were recorded within 72 h after surgery.The quadriceps muscle strength was measured at 1 day before surgery and 12,24,48 and 72 h after surgery.The knee joint range of motion was assessed at 1 day before surgery and 24,48 and 72 h after surgery.Patient′s satisfaction with analgesia was recorded at 72 h after surgery.The adverse reactions within 72 h after surgery were also recorded.Results Compared with R group,VAS scores at rest and during activity were significantly decreased at 12,24,48 and 72 h after surgery,the time to the first pressing analgesia pump was prolonged,the rate of rescue analgesia after surgery was decreased,the score for the patient′s satisfaction with analgesia was increased,the knee joint range of motion was increased(P<0.05),and no significant change was found in the quadriceps muscle strength and incidence of adverse reactions in LB group

关 键 词：布比卡因 脂质体 收肌管 神经传导阻滞 镇痛 关节成形术 置换 膝 

分 类 号：R614[医药卫生—麻醉学]