摘要
背景:术后镇痛是全膝关节置换术(TKA)后处理的重要组成,直接影响术后功能恢复,有利于患者早期活动,积极康复锻炼,并降低并发症发生率。多模式联合镇痛方法是目前术后镇痛研究的热点。目的:评估TKA后采用连续股神经阻滞(CFNB)联合帕瑞昔布的镇痛效果和安全性。方法:2006年9月至2011年12月行初次单侧TKA治疗骨关节炎患者80例,随机分为2组,各40例。联合镇痛组,术后使用CFNB联合帕瑞昔布镇痛模式;连续硬膜外镇痛(CEA)组,术后使用硬膜外自控镇痛泵。术后12、24、48 h采用目测类比疼痛评分法(VAS)分别对患膝静息和活动时进行疼痛评分,记录各组术后4、6、8、10 d的膝关节活动范围(ROM);监测副作用如恶心、呕吐、尿潴留、导管相关问题等。结果:80例患者全部获得随访。两组术后12、24、48 h的静息和活动时的VAS评分比较无统计学差异;两组术后4、6、8、10 d 的患膝 ROM 比较无统计学差异;A 组术后尿潴留、恶心、呕吐的发生率均低于 B 组(P<0.05);两组导管相关并发症发生率无统计学差异(P>0.05)。结论:CFNB联合帕瑞昔布镇痛能有效减轻全膝关节置换术后的疼痛,镇痛效果与CEA相当,副作用少,利于早期功能锻炼。
Background： Pain management after total knee arthroplasty is very important for post-operative rehabilitation and function restoration, and it facilitates early exercise and reduces complications. Multimodal pain management has aroused global re-search interest due to its excellent effect and high safety. Objective： To observe the analgesic effect and safety of continuous femoral nerve block combined with Parecoxib for total knee arthroplasty （TKA）. Methods： Eighty patients scheduled for elective primary unilateral TKA in Department of Orthopedics, Zhongshan Hospital from September 2006 to December 2011 were randomly divided into two groups. In Group A, postoperative analgesia was administered using continuous femoral nerve block combined with Parecoxib. In Group B, postoperative analgesia was ad-ministered using continuous epidural analgesia. The intensity of pain was assessed by Visual Analog Scale （VAS） 12, 24 and 48 h after operation. The knee range of motion （ROM） 4, 6, 8 and 10 days after operation were compared. Side effects such as nausea, vomiting, urinary retention, catheter-related problems were investigated. Results： There was no significant difference in VAS scores of resting and motion pain between Group A and Group B at 12, 24 and 48 h postoperatively. There was no significant difference in ROM between the two groups on postoperative days 4, 6, 8 10. Significantly more side effects such as urinary retention, nausea and vomiting were observed in Group B （P 40.05）. There was no significant difference in incidence of catheter-related problems between the two groups （P 〉 0.05）. Conclusions： Analgesia by continuous femoral nerve block combined with Parecoxib provides effective pain relief after to-tal knee arthroplasty.
出处
《中国骨与关节外科》
2013年第1期17-20,共4页
Chinese Journal of Bone and Joint Surgery
