超声引导下近端收肌管阻滞联合远端腘动脉与膝关节后囊间隙阻滞在全髋关节置换术后镇痛中的应用  

Application of ultrasound-guided proximal adductor block combined with distal popliteal artery and posterior capsule space block in postoperative analgesia of total hip arthroplasty

作　　者：张杰 马艳文 ZHANG Jie;MA Yan-wen(Department of Anesthesiology,Xinxiang Second People's Hospital,Xinxiang 453002,Henan,CHINA)

机构地区：[1]新乡市第二人民医院麻醉科,河南新乡453002

出　　处：《海南医学》2025年第4期503-507,共5页Hainan Medical Journal

基　　金：河南省科技计划项目(编号:192012122021)。

摘　　要：目的探讨超声引导下近端收肌管阻滞(ACB)联合远端腘动脉与膝关节后囊间隙(IPACK)阻滞在全髋关节置换术后镇痛中的应用效果。方法选择2022年5月至2024年5月于新乡市第二人民医院接受全髋关节置换术治疗的180例患者作为研究对象,按照随机数表法分为观察组和对照组各90例。对照组患者采用超声引导下近端ACB阻滞,观察组患者采用超声引导下近端ACB联合远端IPACK阻滞。术后比较两组患者的围术期指标,包括手术时间、麻醉时间、术后补救镇痛患者、术后镇痛泵按压次数、舒芬太尼用量和首次下床时间;术后4 h、8 h、12 h、24 h、48 h分别比较两组患者静息及活动时的视觉模拟评分法(VAS);术前及术后48 h比较两组患者的膝关节活动度;术后24 h及48 h比较两组患者的股四头肌肌力,比较两组患者的不良反应发生率。结果两组患者的手术时间、麻醉时间比较差异均无统计学意义(P>0.05);观察组患者术后补救镇痛患者、术后镇痛泵按压次数、舒芬太尼用量、首次下床时间分别为11.11%、(2.32±0.56)次、(67.94±11.63)μg、(2.68±0.57)d,均少(短)于对照组的26.67%、(4.17±0.86)次、(80.25±14.28)μg、(3.42±0.60)d,差异均有统计学意义(P<0.05)。观察组患者术后4 h、8 h、12 h静息时VAS评分分别为(1.57±0.40)分、(1.86±0.56)分、(2.18±0.58)分,明显低于对照组的(2.58±0.47)分、(3.15±0.76)分、(3.22±0.67)分,术后4 h、8 h、12 h活动时VAS评分分别为(1.85±0.43)分、(2.13±0.48)分、(2.36±0.47)分,明显低于对照组的(2.77±0.44)分、(3.35±0.56)分、(3.48±0.51)分,差异均有统计学意义(P<0.05);观察组患者术后24 h、48 h静息及活动时的VAS评分与对照组比较差异均无统计学意义(P>0.05)。观察组患者术后48 h膝关节活动度为(84.56±7.05)°,明显大于对照组的(78.40±7.82)°,差异有统计学意义(P<0.05)。两组患者术后24 h、48 h的股四头肌肌力比较差异均�Objective To investigate the effect of ultrasound-guided proximal adductor block(ACB)combined with distal interspace between the popliteal artery and the capsule of the posterior knee(IPACK)block in analgesia after total hip replacement.Methods A total of 180 patients who underwent total hip replacement surgery at Xinxiang Second People's Hospital from May 2022 to May 2024 were selected as the study subjects and randomly divided into an observation group and a control group,with 90 patients in each group,using a random number table method.Patients in the control group received ultrasound-guided proximal ACB block,while those in the observation group received ultra-sound-guided proximal ACB combined with distal IPACK block.After surgery,the perioperative indicators were compared between the two groups of patients,including surgery time,anesthesia time,postoperative rescue analgesia rate,number of postoperative analgesia pump presses,the dosage of sufentanil,and time to first ambulation.Visual Analog Scale(VAS)scores at rest and during activity were assessed at 4 h,8 h,12 h,24 h,and 48 h postoperatively and compared between the two groups.Knee range of motion(ROM)was measured preoperatively and at 48 h postoperatively.Quadriceps muscle strength were evaluated at 24 h and 48 h postoperatively,and adverse reaction rates were compared between the two groups.Results There was no statistically significant difference in surgical time and anesthesia time between the two groups of patients(P>0.05).The postoperative rescue analgesia rate,number of postoperative analgesia pump presses,the dosage of sufentanil,and time to first ambulation were 11.11%,(2.32±0.56)times,(67.94±11.63)μg,and(2.68±0.57)d,respectively,which were all significantly less(shorter)than the control group's 26.67%,(4.17±0.86)times,(80.25±14.28)μg,and(3.42±0.60)d(P<0.05).The VAS scores of the observation group at rest at 4 h,8 h,and 12 h after surgery were(1.57±0.40)points,(1.86±0.56)points,and(2.18±0.58)points,respectively,which were significant

关 键 词：全髋关节置换术 镇痛 超声 收肌管阻滞 腘动脉与膝关节后囊间隙阻滞 膝关节活动度 

分 类 号：R687.4[医药卫生—骨科学]