复方倍他米松对坐骨神经联合股神经阻滞下膝关节单髁置换术后爆发痛的影响

Effect of compound betamethasone on breakthrough pain after unicompartmental knee arthroplasty under sciatic nerve combined with femoral nerve block

中文关键词: 爆发痛  神经阻滞  复方倍他米松  地塞米松  膝关节单髁置换术

英文关键词: Breakthrough pain  Nerve block  Betamethason copound injection  Dexamethasone  Unicompartmental knee arthroplasty

中文摘要:

      
目的：探讨复方倍他米松对坐骨神经联合股神经阻滞下膝关节单髁置换术后爆发痛的影响。
方法：选择行单侧膝关节单髁置换术患者100例，男32例，女68例，年龄55~75岁，BMI 18.5～35.0 kg/m²，ASA Ⅰ—Ⅲ级。采用随机数字表法将患者分为三组：无佐剂组（C组，n=34）、地塞米松佐剂组（D组，n=33）和复方倍他米松佐剂组（B组，n=33）。麻醉诱导前三组行坐骨神经阻滞，注入0.4%罗哌卡因15 ml。之后再行股神经阻滞，C组注入0.4%罗哌卡因15 ml，D组注入0.4%罗哌卡因15 ml（含地塞米松5 mg），B组注入0.4%罗哌卡因15 ml（含复方倍他米松4 mg）。记录术后爆发痛发生情况、爆发痛评分、镇痛泵有效按压次数、阿片类药物用量和补救镇痛例数。记录术后0~24 h、24~48 h、48~72 h下地活动距离、睡眠质量评分以及不良事件发生情况。
结果：与C组比较，B组术后爆发痛发生率明显降低(P<0.05)，镇痛泵有效按压次数、阿片类药物用量明显减少(P<0.05)，补救镇痛率和术后第1晚睡眠质量评分明显降低(P<0.05)。与D组比较，B组术后爆发痛发生率和爆发痛评分明显降低(P<0.05)，镇痛泵有效按压次数、阿片类药物用量明显减少(P<0.05)，补救镇痛率和术后第1晚睡眠质量评分明显降低(P<0.05)。三组不同时间段下地活动距离、不良事件发生率差异无统计学意义。
结论：复方倍他米松佐剂可降低坐骨神经联合股神经阻滞下膝关节单髁置换术后爆发痛发生率，提供完善的镇痛效果，减少术后阿片类药物用量，提高患者术后第1晚睡眠质量。

英文摘要:

      
Objective: To investigate the effect of compound betamethasone adjuvant on breakthrough pain after unicompartmental knee arthroplasty under sciatic nerve combined with femoral nerve block.
Methods: A total of 100 patients underwent unicondylar knee arthroplasty, 32 males and 68 females, aged 55-75 years, BMI 18.5-35.0 kg/m², ASA physical status Ⅰ-Ⅲ, were divided into three groups according to random number table method: no adjuvant group (group C, n = 34), dexamethasone adjuvant group (group D, n = 33) and compound betamethasone adjuvant group (group B, n = 33). The patients in the three groups received sciatic nerve block and 0.4% ropivacaine 15 ml before anesthesia induction, then femoral nerve block, 0.4% ropivacaine 15 ml in group C, 0.4% ropivacaine 15 ml in group D (containing dexamethasone 5 mg), and 0.4% ropivacaine 15 ml in group B (containing compound becamethasone 4 mg). The occurrence of breakthrough pain, the number of effective analgesic pump compressions, opioid dosage, and the number of remedial analgesia cases were recorded. The ground movement distance was recorded 0-24 hours, 24-48 hours, and 48-72 hours after operation. The sleep quality scores and adverse events were also recorded.
Results: Compared with group C, the incidence rate of breakthrough pain was lower (P < 0.05), the number of effective analgesia pump compressions, the dosage of opioid, and the sleep quality score on the first night after operation were significantly decreased in group B (P < 0.05). Compared with group D, the incidence rate of breakthrough pain and breakthrough pain score were lower (P < 0.05), the number of effective analgesia pump compressions, the dosage of opioid, and the sleep quality score on the 1st night after operation were significantly decreased in group B (P < 0.05). There was no significant difference in the ground movement distance of in different time periods and incidence of adverse events among the three groups.
Conclusion: Compound betamethasone adjuvant can reduce the incidence of breakthrough pain after unicompartmental knee arthroplasty under sciatic nerve combined with femoral nerve block, provide perfect analgesic effect, reduce postoperative opioid consumption, and improve the sleep quality of patients on the first night after surgery.