收肌管阻滞联合腘丛神经阻滞在关节镜下前交叉韧带重建术后镇痛的应用  

Application of adductor canal block combined with popliteal plexus block in analgesia after anterior cruciate ligament recon⁃struction under arthroscopy

作　　者：王文松 李媛[1] 孙潞 崔晓光 Wang Wensong;Li Yuan;Sun Lu;Cui Xiaoguang(Department of Anesthesiology,the First Affiliated Hospital of Hainan Medical University,Haikou 570102,China)

机构地区：[1]海南医学院第一附属医院麻醉科,海口570102

出　　处：《国际麻醉学与复苏杂志》2024年第10期1054-1061,共8页International Journal of Anesthesiology and Resuscitation

摘　　要：目的探讨超声引导下收肌管阻滞(ACB)联合腘丛神经阻滞(PPB)在膝关节镜下前交叉韧带重建(ACLR)术后镇痛中应用的可行性。方法选取2023年3月至2024年3月在海南医学院第一附属医院拟全麻下行膝关节镜单侧ACLR患者58例,年龄18~60岁,按随机数字表法分为收肌管阻滞组(A组,28例)和收肌管联合腘丛神经阻滞组(AP组,30例)。A组患者在超声引导下以0.25%罗哌卡因+1µg/kg右美托咪定(共15 ml)行ACB;AP组患者在A组的基础上,以0.25%罗哌卡因+1µg/kg右美托咪定(共10 ml)行PPB。之后两组患者均行喉罩全麻。记录患者术后苏醒时(T0)、术后6 h(T_(1))、术后12 h(T_(2))、术后18 h(T_(3))、术后24 h(T_(4))、术后36 h(T_(5))、术后48 h(T_(6))、术后72 h(T_(7))时的静息和运动视觉模拟评分法(VAS)疼痛评分、患肢足运动功能评分、股四头肌肌力分级,患肢足运动功能和股四头肌肌力减弱例数;记录首次补救镇痛时间,术后双氯芬酸钠用量,补救镇痛率和小腿内侧感觉恢复正常时间;记录阻滞前、阻滞10 min后、手术开始时、手术结束时、术后6 h、术后12 h时的平均动脉压(MAP)、心率;记录术中低血压、心动过缓,术后并发症(恶心呕吐、院内跌倒)及神经阻滞相关并发症(神经损伤、穿刺部位血肿、感染)等不良反应发生情况。结果与A组比较,AP组T0、T_(1)、T_(2)、T_(5)时静息和运动VAS疼痛评分较低(均P<0.05),T_(3)、T_(4)、T_(6)、T_(7)时静息和运动VAS疼痛评分差异无统计学意义(均P>0.05),术后首次补救镇痛时间较长,术后双氯芬酸钠用量较少,补救镇痛率较低(均P<0.05)。两组患者各时点股四头肌肌力分级、患肢足运动功能评分、股四头肌肌力减弱例数、患肢足运动功能减弱例数、小腿内侧感觉恢复正常时间差异无统计学意义(均P>0.05)。AP组阻滞10 min后的MAP、心率低于A组(均P<0.05),两组患者阻滞前、手术开始时、手术结束时、术后6Objective To explore the feasibility of ultrasound‑guided adductor canal block(ACB)combined with popliteal plexus block(PPB)in analgesia after anterior cruciate ligament reconstruction(ACLR)under knee arthroscopy.Methods A total of 58 patients,aged 18‒60 years,scheduled for unilateral ACLR under general anesthesia at the First Affiliated Hospital of Hainan Medi‑cal University from March 2023 to March 2024,were selected,According to the random number table method,they were divided into two groups:an adductor canal block group(group A,n=28)and an adductor canal block combined with popliteal plexus block group(group AP,n=30).In group A,patients received ACB under ultrasound guidance with 0.25%ropivacaine+1µg/kg dexmedetomidine(15 ml in total).In group AP,patients received underwent PPB with 0.25%ropivacaine+1µg/kg dexmedetomidine(10 ml in total for PPB),in addition to the same treatment in group A.All the patients were subsequently subject to general anesthesia via laryngeal mask airway.The Visual Analog Scale(VAS)at rest and during movement,limb motor function,quadriceps muscle strength grading at the time of postoperative recovery(T0),6 h(T_(1)),12 h(T_(2)),18 h(T_(3)),24 h(T_(4)),36 h(T_(5)),48 h(T_(6)),and 72 h(T_(7)),and the number of weak‑ened cases of limb motor function and quadriceps muscle strength grading were recorded;additional parameters recorded,time to first rescue analgesia,use of diclofenac sodium postoperatively,rate of rescue analgesia,and time to sensory recovery of the medial calf;mean arterial pressure(MAP)and heart rate were recorded at 10 min after block,at surgery start,surgery end,and at postoperative 6 h and 12 h;the incidences of hypotension,bradycardia,and postoperative complications(nausea,vomiting,and falls)as well as nerve block‑related complications(nerve injury,hematoma,and infection)were also noted.Results Compared with group A,group AP showed significant decreases in VAS scores at rest and during at T0,T_(1),T_(2),and T_(5)(all P<0.05),while differences at T_(3),T_(4)

关 键 词：收肌管阻滞 腘丛神经阻滞 前交叉韧带重建术 术后镇痛 

分 类 号：R614[医药卫生—麻醉学]