ACB+iPACK联合神经阻滞与局部浸润在TKA中的应用比较研究  

Comparative study on the application of ACB+iPACK combined nerve block versus local infiltration during total knee arthroplasty procedure

作　　者：孙再娇 熊翔 普建学 唐玲玲 刘萍 孙美荣 SUN Zaijiao;XIONG Xiang;PU Jianxue;TANG Lingling;LIU Ping;SUN Meirong(Department of Anesthesiology,the Third People's Hospital of Yunnan Province,Kunming,Yunnan 650200,China;不详)

机构地区：[1]云南省第三人民医院麻醉科,昆明650200 [2]云南省第三人民医院骨科,昆明650200 [3]峨山县人民医院骨科,云南玉溪653200 [4]峨山县人民医院麻醉科,云南玉溪653200

出　　处：《中国骨科临床与基础研究杂志》2024年第5期340-346,共7页Chinese Journal of Orthopaedic Clinical and Basic Research

基　　金：云南省第三人民医院院级课题(2024SSYKT36)。

摘　　要：目的对比超声引导下收肌管阻滞(ACB)联合腘动脉与膝关节后囊间隙(iPACK)阻滞和局部浸润镇痛在全膝关节置换术(TKA)中的应用效果。方法将2023年6月至2024年6月云南省第三人民医院行TKA治疗的80例单侧膝关节骨性关节炎患者随机分为两组,其中40例行后关节囊、滑膜、皮下组织逐层局部浸润注射镇痛(局部浸润组),40例行超声引导下ACB+iPACK联合神经阻滞(神经阻滞组)。比较两组患者一般手术指标,术后各时间点吗啡使用率、运动和静息视觉模拟量表(VAS)评分、15项恢复质量(QoR-15)量表评分和肌力变化,以及不良事件和并发症发生情况。结果两组患者手术时间、麻醉时间、住院时间等一般手术指标,术后各时间点吗啡使用率和运动VAS评分,术后24、48、72 h静息VAS评分、QoR-15评分以及术后睡眠中断、恶心、呕吐、头晕发生率比较,差异无统计学意义(P>0.05)。神经阻滞组入PACU和术后2、6、12 h静息VAS评分、住院总费用高于局部浸润组,术后24、48、72 h肌力弱于局部浸润组,两组比较,差异有统计学意义(P<0.05)。结论ACB+iPACK联合神经阻滞和局部浸润两种镇痛方式均能有效缓解TKA术后疼痛,安全性高。其中局部浸润早期镇痛效果更好,住院总费用更低,且ACB+iPACK联合神经阻滞对术后肌力有一定影响,建议有经验的手术医生在TKA术后首选局部浸润镇痛,镇痛不足的情况下再追加神经阻滞或其他辅助镇痛药物。Objective To compare the application effects of ultrasound-guided adductor canal block(ACB)combined with interspace between the popliteal artery and the posterior knee capsule(iPACK)block versus local infiltration analgesia(LIA)during total knee arthroplasty(TKA)procedure.Methods From June 2023 to June 2024,80 patients with unilateral knee osteoarthritis undergoing TKA at the Third People's Hospital of Yunnan Province were randomly divided into two groups.Forty patients received LIA through layer-by-layer injection into the posterior joint capsule,synovium,and subcutaneous tissue(LIA group),while 40 patients underwent ultrasound-guided ACB+iPACK combined nerve block(nerve block group).The general surgical indicators,morphine consumption rate at various postoperative time points,visual analog scale(VAS)scores for movement and rest,15-item quality of recovery(QoR-15)scale scores,muscle strength changes,and occurrences of adverse events and complications were compared between the two groups.Results There were no statistically significant differences between the two groups in general surgical indicators such as operation time,anesthesia time,and length of stay;morphine consumption rate and movement VAS scores at various postoperative time points;resting VAS scores,QoR-15 scale scores at 24,48,and 72 hours postoperatively;and incidence rates of postoperative sleep disruption,nausea,vomiting,and dizziness(P>0.05).The nerve block group had higher resting VAS scores upon admission to the postanesthesia care unit(PACU)and at 2,6,and 12 hours postoperatively,higher total hospitalization costs,and weaker muscle strength at 24,48,and 72 hours postoperatively compared to the LIA group,with statistically significant differences(P<0.05).Conclusions Both ACB+iPACK combined nerve block and LIA can effectively alleviate postoperative pain after TKA with high safety.The LIA group exhibited better early analgesia efficacy and lower total hospitalization costs.Additionally,ACB+iPACK combined nerve block had a certain impact on postop

关 键 词：关节成形术 置换 膝 疼痛 手术后 镇痛 超声检查 膝关节 肌 骨骼 神经传导阻滞 局部浸润 肌力 

分 类 号：R687.42[医药卫生—骨科学] R614.4[医药卫生—外科学]