摘要
目的评价收肌管阻滞联合闭孔神经后支阻滞用于全膝关节置换术老年病人术后镇痛的效果。
方法择期行单侧全膝关节置换术病人60例，性别不限，年龄65～75岁，体重55～80 kg，ASA分级Ⅰ或Ⅱ级，采用随机数字表法分为2组（n＝30）：收肌管阻滞组（A组）和收肌管阻滞联合闭孔神经后支阻滞组（AO组）。麻醉诱导结束后，2组在超声引导下行收肌管阻滞，注入0.5%罗哌卡因20 ml，然后AO组在超声引导下行闭孔神经后支阻滞，注入0.5%罗哌卡因10 ml。术后VAS评分≥3分时行PCIA，所用药物为吗啡0.05 mg/kg，锁定时间10 min。若VAS评分仍≥3分，静脉注射吗啡0.025 mg/kg补救镇痛。记录术后首次使用镇痛药物时间、术后24和48 h内吗啡用量、术后48 h病人镇痛满意度评分和神经阻滞相关并发症、恶心、呕吐、瘙痒等不良反应的发生情况。
结果与A组比较，AO组首次使用镇痛药物时间延长，术后24 h吗啡用量减少（P〈0.05）；2组术后48 h吗啡用量、镇痛满意度评分、恶心、呕吐及瘙痒的发生率比较差异无统计学意义（P〉0.05）。2组均未见神经阻滞相关并发症的发生。
结论收肌管阻滞联合闭孔神经后支阻滞用于全膝关节置换术老年病人术后镇痛效果优于单纯收肌管阻滞。
Objective To evaluate the efficacy of adductor canal block combined with posterior branch of obturator nerve block for postoperative analgesia in the elderly patients undergoing total knee ar- throplasty. Methods Sixty American Society of Anesthesiologists physical status I or 11 patients of both sexes, aged 65-75 yr, weighing 55-80 kg, scheduled for elective unilateral total knee arthroplasty, were divided into 2 groups （n= 30 each） using a random number table： adductor canal block group （group A） and blockade of adductor canal and posterior branch of obturator nerve group （ group AO）. At the end of anesthesia induction, adductor canal block was performed under ultrasound guidance, and 0.5% ropiva- caine 20 ml was injected in A and AO groups, and in addition posterior branch of obturator nerve block was then performed under ultrasound guidance, and 0. 5% ropivacaine 10 ml was injected in group AO. When postoperative visual analog scale score 〉 3, patient-controlled intravenous analgesia was performed with mor- phine 0. 05 mg/kg at a 10-min interval. When postoperative visual analog scale score was still1〉 3, mor- phine 0. 025 mg/kg was intravenously injected as rescue analgesic. The duration of first requirement for an- algesic, consumption of morphine within 24 and 48 h after operation, patient＇s satisfaction with analgesia at 48 h after operation and development of nerve block-related complications and adverse reactions such as nau- sea, vomiting and itching were recorded. Results Compared with group A, the duration of first require- ment for analgesic was significantly prolonged, and the consumption of morphine within 24 h after operationwas reduced in group AO （P〈0.05）. There was no significant difference between the two groups in the consumption of morphine within 48 h after operation, satisfaction score or incidence of nausea, vomiting and itching （P〉0.05）. Nerve block-related complications were not found in two groups. Conclusion Ad- ductor canal block combined with posteri
出处
《中华麻醉学杂志》
CSCD
北大核心
2017年第11期1365-1367,共3页
Chinese Journal of Anesthesiology
关键词
关节成形术
置换
膝
神经传导阻滞
收肌管
闭孔神经
镇痛
Arthroplasty,replacemnt,knee
Nerve black
Adductor canal
obturator nerve
Analgesia
