摘要
目的:研究超声引导下连续股神经阻滞在全膝关节置换(TKA)术后镇痛的可行性及应用效果,为全膝关节置换术后镇痛提供参考依据。方法:选取择期行单侧全膝关节置换术的患者40例,ASAⅠ～Ⅲ级,按随机化表分为两组,每组20例。连续硬膜外组(PCA)术后48 h持续硬膜外输注0.25%罗哌卡因镇痛,连续股神经镇痛组(CFNB)术后48 h持续输注0.25%罗哌卡因镇痛;记录术后4 h、8 h、12 h、24 h、36 h、48 h两组患者静息与活动状态下的VAS评分,需要追加静脉镇痛药物的情况,并随访神经损伤、局部麻醉药中毒以及恶心、呕吐,尿潴留等不良反应的情况。结果:股神经组和硬膜外组的静息痛VAS评分比较,差异无统计学意义(P>0.05),术后8 h,12 h,24 h,48 h活动痛的VAS评分硬膜外组低于股神经组,差异有统计学意义(P<0.05)、镇痛满意度评分股神经组高于硬膜外组,差异有统计学意义(P<0.05)。股神经组术后低血压、尿潴留等不良反应的发生率明显低于硬膜外组,差异有统计学意义(P<0.05)。股神经组有4例追加帕瑞昔布钠,硬膜外组有3例追加帕瑞昔布钠。结论:连续股神经阻滞和硬膜外阻滞均可以为TKA术后患者提供满意的静息状态下镇痛,但是连续股神经阻滞可以明显降低患者术后尿潴留、低血压的发生率,使得患者术后镇痛的满意度明显提高。
Objective To study the application effect of continuous femoral nerve block guided by ultrasound in postoperative pain undergoing total knee replacement. Method 40 cases of patients undergoing total knee replacement were selected as the study objects.ASA physical status Ⅰ~Ⅲ.Patients were enrolled and randomly divided into continuous femoral nerve block guided by ultrasound(CFNB) group and patient controlled analgesia(PCA) group,with 20 cases in each.All patients had a 5 ml bolus of ropivacaine 0.25% via the catheter followed by an infusion of ropivacaine 0.25% at 2 ml/h for 48 h.Visual analogue score(VAS) during rest and movement after surgery were acquired to record at 4 h,8 h,12 h,24 h,36 h,48 h postoperative point.Hypotention,nausea and vomit,nerve injury,retention of urine,additional intravenous analgesics consumption were also recorded.Results There were no significant differences in the VAS during rest after surgery(P>0.05).The VAS during movement at 8 h,12 h,24 h,48 h in the CFNB group after surgery were higher than PCA group(P<0.05).The satisfaction scores in CFNB group was higher than PCA group(P<0.05).The side effect rate of hypotension and retention of urine in the CFNB group was lower than PCA group(P<0.05).There were 4 patients added intravenous analgesics in CFNB group and 3 patients in PCA group.Conclusion All of CFNB and PCA can provide satisfactory rest analgesia, CFNB can obviously decrease the hypotension and retention of urine after surgery,improve the satisfaction of the patients.
作者
汪威廉
倪娟
肖锦亮
张畅
王力甚
WANG Wei-lian;NI Juan;XIAO Jin-liang(Department of Anesthesiology,Jingzhou Central Hospital,Jingzhou 434020,China)
出处
《吉林医学》
CAS
2019年第5期959-962,共4页
Jilin Medical Journal
基金
2016年荆州市科技局计划项目[项目编号:2016100]
关键词
股神经阻滞
全膝关节置换
硬膜外镇痛
超声
Continuous femoral nerve block
Total knee replacement
PCA
Ultrasound
