神经阻滞在前交叉韧带重建术后早期镇痛中的临床应用  

Clinical application of nerve block in early analgesia after anterior cruciate ligament reconstruction

作　　者：刘丙根 陈思锋 张催 雷鸣 张管 LIU Bing-gen;CHEN Si-feng;ZHANG Cui;LEI Ming;ZHANG Guan(Department of Orthopaedics,Yichun People's Hospital,Yichun336000,Jiangxi,China;Department of Anesthesiology,Yichun People's Hospital,Yichun336000,Jiangxi,China)

机构地区：[1]宜春市人民医院骨科,江西宜春336000 [2]宜春市人民医院麻醉科,江西宜春336000

出　　处：《中国骨伤》2025年第3期287-292,共6页China Journal of Orthopaedics and Traumatology

基　　金：江西省科技计划项目(编号:202312217)。

摘　　要：目的:探讨前交叉韧带(anterior cruciate ligament,ACL)重建术采用蛛网膜下腔阻滞(subarachnoid block,SA)、收肌管神经阻滞(adductor canal block,ACB)与股神经阻滞(femoral nerve block,FNB)早期镇痛的有效性与安全性。方法:自2022年9月至2023年10月选取接受单侧膝关节镜下ACL重建术治疗的90例ACL断裂患者,按照麻醉方式不同分为ACB组、FNB组和SA组,每组30例。ACB组男12例,女18例;年龄18~60(33.3±13.8)岁;美国麻醉医师协会(American Society of Aneshesiologists,ASA)分级Ⅰ级14例,Ⅱ级16例;左侧13例,右侧17例。FNB组男15例,女15例;年龄18~60(33.5±12.9)岁;ASA分级Ⅰ级15例,Ⅱ级15例;左侧16例,右侧14例。SA组男16例,女14例;年龄18~60(31.0±12.6)岁;ASA分级Ⅰ级18例,Ⅱ级12例;左侧17例,右侧13例。ACB、FNB组在SA麻醉前行超声引导下行ACB和FNB神经阻滞,用药为0.3%罗哌卡因15 ml。分别记录并比较术后4、8、12、16、24、48 h时3组静息状态和被动运动时疼痛视觉模拟评分(visual analogue scale,VAS)及股四头肌肌力情况,术后48 h内曲马多用量、恶心呕吐发生率、神经阻滞时间及其他并发症。结果:所有患者获得随访,时间11~20(15.8±2.4)个月。SA组术后4、8、12、16、24及48 h静息和被动运动VAS明显高于ACB组和FNB组,差异有统计学意义(P<0.05);ACB组术后4、8、12、16、24及48 h静息和被动运动VAS与FNB组比较,差异无统计学意义(P>0.05)。术后4、8、12、16 h,SA组和ACB组股四头肌肌力高于FNB组,差异有统计学意义(P<0.05);但术后24、48 h,3组股四头肌肌力两两比较,差异无统计学意义(P>0.05)。ACB组术后1例发生恶心呕吐,FNB组2例,SA组5例;3组比较差异无统计学意义(χ2=0.352,P=0.171)。SA组术后曲马多用量为(300.00±136.50)mg,高于FNB组(168.33±73.70)mg和ACB(163.33±70.70)mg,差异有统计学意义(P<0.05)。ACB组和FNB组神经阻滞时间比较差异无统计学意义(P>0.05)。3组均未出现穿刺部位出血、局麻药�Objective To explore clinical effective and safety of subarachnoid block(SA),adductor canal block(ACB),and femoral nerve block(FNB)for early analgesia in anterior cruciate ligament(ACL)reconstruction.Methods From September 2022 to October 2023,90 patients with ACL rupture who received unilateral knee arthroscopic ACL reconstruction were selected and divided into ACB group,FNB group and SA group according to different anesthesia methods,with 30 patients in each group.There were 12 males and 18 females in ACB group,aged from 18 to 60 years old with an average of(33.3±13.8)years old;14 patients with gradeⅠand 16 patients with gradeⅡaccording to American Society of Aneshesiologists(ASA);13 patients on the left side and 17 patients on the right side.There were 15 males and 15 females in FNB group,aged from 18 to 60 years old with an average of(33.5±12.9)years old;15 patients with gradeⅠand 15 patients with gradeⅡ;16 patients on the left side and 14 patients on the right side.There were 16 males and 14 females in SA group,aged from 18 to 60 years old with an average of(31.0±12.6)years old;18 patients with grade I and 12 patients with gradeⅡ;17 patients on the left side and 13 patients on the right side.In ACB and FNB groups,the nerve block of ACB and FNB were performed under ultrasound guidance before SA anesthesia with 15 ml of 0.3%ropivacaine.Visual analogue scale(VAS)and quadriceps muscle strength at rest and passive movement were recorded and compared among 3 groups at 4,8,12,16,24 and 48 h after operation,as well as the dosage of tramadol injection analgesics,incidence of nausea and vomiting,nerve block time and other complications within 48 h after operation were compared.Results All patients were followed up for 11 to 20(15.8±2.4)months.VAS at 4,8,12,16,24 and 48 h after operation of SA group was significantly higher than that of ACB and FNB groups,with statistical significance(P<0.05).There were no significant difference in VAS of rest and passive movement at 4,8,12,16,24 and 48 h after operation

关 键 词：收肌管神经阻滞 股神经阻滞 前交叉韧带重建术 镇痛效果 

分 类 号：R274.9[医药卫生—中西医结合]