超声引导下隐神经联合腘动脉与膝关节后囊间隙阻滞在全膝关节置换术后镇痛中的应用

Application of ultrasound-guided saphenous nerve block combined with interspace between the popliteal artery and the capsule of the posterior knee block in analgesia after total knee arthroplasty

中文关键词: 超声引导  隐神经阻滞  胭动脉与膝关节后囊间隙阻滞  全膝关节置换术

英文关键词: Ultrasound-guided  Saphenous nerve block  IPACK block  Total knee arthroplasty

中文摘要:

      
目的 评价超声引导下隐神经联合腘动脉与膝关节后囊间隙（IPACK）阻滞对全膝关节置换术后镇痛效果及运动功能的影响。
方法 选择2018年9月至2019年11月拟行首次单侧全膝关节置换术患者60例，男25例，女35例，年龄50~80岁，BMI 18~25 kg/m²，ASA Ⅰ—Ⅲ级。将患者随机分为两组：隐神经联合IPACK阻滞组（SP组）和隐神经阻滞组（SN组），每组30例。麻醉诱导前两组患者均行超声引导下隐神经阻滞，注入0.375%罗哌卡因15 ml。SP组随后行超声引导下IPACK阻滞，注入0.25%罗哌卡因20 ml。SN组不予IPACK阻滞。记录阻滞成功例数、术中舒芬太尼和瑞芬太尼用量、苏醒后30 min、术后1、2、3 d膝关节活动度和最长行走距离、术后6、12、24、48、72 h静息和运动时VAS疼痛评分和神经阻滞相关不良反应的发生情况。
结果 两组阻滞成功率、阿片类药物用量、术后膝关节活动度差异无统计学意义。术后1 d SP组最长行走距离明显长于SN组（P<0.05）。术后12、24 h SP组运动时VAS疼痛评分明显低于SN组（P<0.05）。SP组有1例在苏醒后有轻微足下垂，观察至术后1 d好转。
结论 超声引导下隐神经联合IPACK阻滞用于全膝关节置换术，可提供较完善的镇痛效果，更利于患者早期功能锻炼。

英文摘要:

      
Objective To evaluate the effect of ultrasound-guided saphenous nerve block combined with interspace between the popliteal artery and the capsule of the posterior knee (IPACK) block for early ambulation ablity and postoperative analgesia after total knee arthroplasty.
Methods Sixty patients from September 2018 to Novermber 2019 were enrolled, aged 50-80 years, BMI 18-25 kg/m², ASA physical status Ⅰ-Ⅲ scheduled for primary unilateral total knee arthroplasty, were randomly divided into two groups (n = 30): saphenous nerve block combined with IPACK block group (group SP) and saphenous nerve block group (group SN). All patients received ultrasound-guided nerve block before induction of anesthesia. Saphenous nerve block was performed under ultrasound guidance with 0.375% ropivacaine 15 ml in the two groups, and the addition IPACK block were performed with 0.25% ropivacaine 20 ml in group SP. The success rate of nerve block, the consumption of sufentanil and remifentanil during operaction, the knee joint range of motion, walking distance on the operation day, 1, 2 and 3 days after operation, the VAS scores at rest and during exercise were assessed 6, 12, 24, 48, and 72 hours after operation, the occurrence of adverse reactions assioated with nerve block were all recorded.
Results The success rate of nerve block, the consumption of opioids, the postoperative range of motion and the VAS scores at rest between two groups showed no statistically significant differences. Compared with group SN, the walking distance on 1day after operation was significantly farther and the VAS scores during exercise 12 and 24 hours after the operation were significantly lower in group SP (P < 0.05). One patient in group SP had slight foot-drop after analepsia, and it recovered 1 day after operation.
Conclusion Ultrasound-guided saphenous nerve block combined with IPACK block can provide relatively perfect analgesia efficacy and better early rehabilitation after total knee arthroplasty．