腘丛神经阻滞联合收肌管阻滞用于全膝关节置换术患者术后镇痛的效果

Analgesic effect of popliteal plexus block combined with adductor canal block after total knee arthroplasty

中文关键词: 腘丛神经  收肌管  神经阻滞  全膝关节置换术  镇痛

英文关键词: Popliteal plexus  Adductor canal  Nerve block  Total knee arthroplasty  Analgesic effect

中文摘要:

      
目的 观察腘丛神经阻滞（PPB）联合收肌管阻滞（ACB）用于全膝关节置换术（TKA）患者术后镇痛的效果。
方法 选择初次进行全身麻醉下单侧TKA的患者60例，男15例，女45例，年龄50～80岁，BMI 18～30 kg/m²，ASA Ⅰ—Ⅲ级。采用随机数字表法将患者分为两组：PPB联合ACB组（P组）和ACB组（A组），每组30例。麻醉诱导前，P组采用0.5%罗哌卡因15 ml行ACB，后采用0.5%罗哌卡因20 ml行PPB，A组单纯采用0.5%罗哌卡因15 ml行ACB。记录术中瑞芬太尼总量和手术时间。记录术后4、8、24、48、72 h静息和活动时VAS疼痛评分，术后1、2、3 d主动屈膝最大角度，术后4、8、24 h患肢运动阻滞情况。记录镇痛泵总按压次数、有效按压次数和补救镇痛情况。记录首次下床活动时间、术后住院时间、患者术后满意度评分以及术后不良事件发生情况。
结果 与A组比较，P组术后4、8、24、48、72 h静息时VAS疼痛评分明显降低（P＜0.05），术后4、8 h时活动时VAS疼痛评分明显降低（P＜0.05），术后1、2 d主动屈膝最大角度明显增大（P＜0.05），术后镇痛泵总按压次数和有效按压次数明显减少，补救镇痛率明显降低（P＜0.05），术后住院时间明显缩短，患者术后满意度评分明显升高（P＜0.05）。两组患肢运动阻滞情况差异无统计学意义。两组均未见术后局麻药中毒、穿刺部位感染、血肿、院内跌倒等不良事件发生。
结论 腘丛神经阻滞联合收肌管阻滞不影响患者下肢的运动功能，有利于患者早期下床活动，缩短术后住院时间，提高患者满意度，促进患者早期康复，为全膝关节置换术患者提供更加完善的镇痛效果。

英文摘要:

      
Ojective To observe the effect of popliteal plexus block (PPB) combined with adductor canal block (ACB) for patients after total knee arthroplasty (TKA).
Methods Sixty patients who underwent unilateral TKA were selected, 15 males and 45 females, aged 50-80 years, BMI 18-30 kg/m², ASA physical status Ⅰ-Ⅲ. Patients were divided into two groups: PPB combined with ACB group (group P) and ACB only group (group A) by random number table method, 30 patients in each group. ACB was performed with 15 ml of 0.5% ropivacaine and PPB was performed with 20 ml of 0.5% ropivacaine in group P before anestheic induction. And only ACB with 0.5% ropivacaine 15 ml was performed in group A. The dosage of remifentanil and the time of operation were recorded. And the pain VAS score at rest and in motion were recorded 4, 8, 24, 48, 72 hours after surgery. The maximum range of knee motion was recorded 1, 2, 3 days after operation. The motion block of the limb affected was observed 4, 8, 24 hours after surgery. The total compression times, effective compression times of analgesic pump, and the requirements for rescue analgesia were also documented. The first time of patient out of bed, postoperative hospital stay, satisfaction score of patients after operation and adverse events were recorded.
Results Compared with group A, the VAS score of patients in group P at rest 4, 8, 24, 48, 72 hours after operation was significantly lower (P < 0.05), the VAS score of patients in group P in motion 4 and 8 hours after operation was significantly lower (P < 0.05), and the range of motion of the knee from 1 to 2 day in group P was significantly increased (P < 0.05), the rescue analgesia times, the total compression times and effective compression times of analgesic pump in group P were significantly lower (P < 0.05), the postoperative hospital stay was significantly shortened, and the patient satisfaction in group P was significantly improved (P < 0.05). There was no significant difference in motion block of the affected side limb between the two groups. There were no adverse events such as postoperative local anesthetic poisoning, puncture site infection, hematoma, and falls inside hospital in the two groups.
Conclusion Popliteal plexus block combined with adductor canal block provides improved the analgesic effect for TKA patients without affecting the motor function, conducive to early ambulation of patients, shortens the hospital stay, improves patient satisfaction, and promotes early recovery of patients.