不同浓度罗哌卡因收肌管阻滞结合股外侧皮神经阻滞用于全膝关节置换术后的镇痛效果研究  

Study on analgesic effect of adductor canal block under different concentrationsof ropivacaine combined with lateral femoral cutaneous nerve block after total knee arthroplasty

作　　者：崔翔 何坤鹏 任凯[1] 范俊柏[1,2] CUI Xiang;HE Kunpeng;REN Kai;FAN Junbai(College of Anesthesia,Shanxi Medical University,Taiyuan,Shanxi 030000,China;Department of Anesthesiology,Second Hospital of Shanxi Medical University,Taiyuan,Shanxi 030000,China)

机构地区：[1]山西医科大学麻醉学院,太原030000 [2]山西医科大学第二医院麻醉科,太原030000

出　　处：《重庆医学》2024年第22期3458-3462,共5页Chongqing Medical Journal

摘　　要：目的比较超声引导下不同浓度罗哌卡因收肌管阻滞(ACB)结合股外侧皮神经阻滞(LFCNB)用于全膝关节置换术(TKA)后的镇痛效果及对膝关节功能的影响。方法选取在蛛网膜下腔阻滞接受原发性单侧TKA的患者90例,随机分为3组:0.20%罗哌卡因组(A组,n=30)、0.25%罗哌卡因组(B组,n=30)和0.30%罗哌卡因组(C组,n=30)。3组于术前行ACB+LFCNB,记录术后视觉模拟评分(VAS评分)、术后24 h内的镇痛药物舒芬太尼消耗量、首次抢救镇痛时间、术后膝关节活动度(ROM)、股四头肌力量和术后并发症发生情况。结果与A组相比,B组和C组在术后4、8、12、24 h静息时的VAS评分均降低(P<0.05)、术后24 h内的舒芬太尼消耗量减少(P<0.05)、首次抢救镇痛时间延长(P<0.05),术后当天的膝关活动度升高(P<0.05),以上结果在B组与C组间差异无统计学意义(P>0.05)。3组在术后第1天和第2天的ROM、术后股四头肌力量和并发症的发生率差异无统计学意义(P>0.05)。结论ACB+LFCNB用于TKA的患者时,与0.20%的罗哌卡因相比,0.25%和0.30%罗哌卡因可以改善术后的早期疼痛,有利于术后膝关节的功能恢复,0.25%罗哌卡因可以提供与0.30%罗哌卡因相同镇痛效果。Objective To compare the analgesic effects of ultrasound-guided adductor canal block(ACB)under different concentrations of ropivacaine combined with lateral femoral cutaneous nerve block(LFCNB)after total knee arthroplasty(TKA)and their influence on the knee joint function.Methods Ninety patients undergoing primary unilateral TKA under subarachnoid block were selected and randomly divided into three groups:0.20%ropivacaine(group A),0.25%ropivacaine(group B),and 0.30%ropivacaine(group C).All groups conducted ACB+LFCNB preoperatively.Postoperative visual analog scale(VAS)scores,sufentanil consumption at postoperative 24 h,time to first rescue analgesia,postoperative range of motion(ROM)of the knee joint,quadriceps strength and postoperative complications were recorded.Results Compared with the group A,the resting and moving VAS scores at postoperative 4,8,12,24 h in the group B and C were decreased(P<0.05),the sufentanil consumption amount within postoperative 24 h was decreased(P<0.05),the first rescue analgesia time was prolonged(P<0.05),ROM on the operation day was increased(P<0.05).The above results had no statistical difference between the group B and group C(P>0.05).There were no statistically significant differences in knee ROM on postoperative 1,2 d,postoperative quadriceps strength and complications incidence rates among the three groups(P>0.05).Conclusion In the application of ACB+LFCNB in the patients with TKA,compared with 0.20%ropivacaine,0.25%and 0.30%ropivacaine could improve early postoperative pain and facilitate the postoperative functional recovery of the knee joint.Additionally,0.25%ropivacaine could provide the same analgesic efficacy as 0.30%ropivacaine.

关 键 词：罗哌卡因 收肌管阻滞 股外侧皮神经 全膝关节置换术 膝关节功能 

分 类 号：R614.4[医药卫生—麻醉学]