摘要
目的比较股三角与收肌管入路隐神经阻滞用于全膝关节置换术病人术后镇痛的效果。方法择期全麻下行全膝关节置换术病人60例,年龄53~68岁,性别不限,ASA分级Ⅰ或Ⅱ级,采用随机数字表法分为2组(n=30):股三角入路隐神经阻滞组(F组)和收肌管入路隐神经阻滞组(A组)。F组和A组分别于麻醉诱导前行股三角入路隐神经阻滞和收肌管入路隐神经阻滞,分别注射0.5%罗哌卡因20 ml。2组术后病人自控隐神经阻滞镇痛,镇痛泵配方:1%罗哌卡因400 mg,用0.9%氯化钠注射液稀释至160 ml,背景输注速率5 ml/h,PCA剂量5 ml,锁定时间30 min,镇痛至术后72 h。VAS评分>4分时,病人按压镇痛泵后30 min疼痛未缓解,则肌肉注射盐酸哌替啶100 mg镇痛补救。分别于术后4、8、24、48和72 h时,采用徒手肌力法评定患肢股四头肌肌力。记录术后72 h时患者满意度评分。记录术后72 h内镇痛补救情况及不良反应(局麻药中毒、瘙痒、头晕、尿潴留和恶心呕吐等)发生情况。结果与F组比较,A组术后4、8和24 h时患肢股四头肌肌力增加,术后镇痛补救率降低(P<0.05),病人满意度评分和术后不良反应发生率差异无统计学意义(P>0.05)。结论收肌管内隐神经阻滞用于全膝关节置换术病人术后镇痛的效果优于股三角内隐神经阻滞。
Objective To compare the efficacy of femoral triangle versus adductor canal approach to saphenous nerve block for postoperative analgesia in the patients undergoing knee arthroplasty.Methods Sixty American Society of Anesthesiologists physical statusⅠorⅡpatients of both sexes,aged 53-68 yr,scheduled for elective total knee arthroplasty under general anesthesia,were assigned into 2 groups(n=30 each)using a random number table method:femoral triangle approach to saphenous nerve block group(group F)and adductor canal approach to saphenous nerve block group(group A).Femoral triangle and adductor canal approach to saphenous nerve block was performed by injecting 0.5%ropivacaine 20 ml in group F and group A,respectively.Patient-controlled saphenous nerve block analgesia was used in two groups,and the analgesic pump solution contained 1%ropivacaine 400 mg diluted to 160 ml in 0.9%sodium chloride injection.The analgesic pump was set up with a 5 ml bolus dose,a 30-min lockout interval and background infusion at a rate of 5 ml/h,and analgesia lasted until 72 h after operation.When visual analog scale score>4 and pain was not relived after 30-min pressing by patients,pethidine hydrochloride 100 mg was intramuscularly injected as rescue analgesic.The muscle strength of quadriceps femoris was assessed by manual muscle test at 4,8,24,48 and 72 h after operation.The patient′s satisfaction score was assessed and recorded at 72 h after operation.Rescue analgesia and development of adverse reactions(local anesthetic intoxication,itching,dizziness,urinary retention,nausea and vomiting)were recorded within 72 h after operation.Results Compared with group F,the muscle strength of quadriceps femoris was significantly increased at 4,8 and 24 h after operation,the rate of postoperative rescue analgesia was decreased(P<0.05),and no significant change was found in patient′s satisfaction score or incidence of adverse reactions in group A(P>0.05).Conclusion Adductor canal approach to saphenous nerve block provides better efficacy fo
作者
王春光
张志强
李艳军
白艳辉
王园园
李庆辉
刘嘉运
柳进宁
高美娜
郭小雨
Wang Chunguang;Zhang Zhiqiang;Li Yanjun;Bai Yanhui;Wang Yuanyuan;Li Qinghui;Liu Jiayun;Liu Jinning;Gao Meina;Guo Xiaoyu(Department of Anesthesiology,The First Center Hospital of Baoding,Baoding 071000,China;Department of Cardiothoracic Surgery,The First Center Hospital of Baoding,Baoding 071000,China;Department of Orthopedics,The First Center Hospital of Baoding,Baoding 071000,China;Department of Medical Ultrasonics,The First Center Hospital of Baoding,Baoding 071000,China)
出处
《中华麻醉学杂志》
CAS
CSCD
北大核心
2019年第8期953-956,共4页
Chinese Journal of Anesthesiology
基金
河北省医学科学研究课题计划项目(20191236)。
关键词
神经传导阻滞
关节成形术
置管
膝
收肌管
股三角
Nerve Block
Arthroplasty,replacement,knee
Adductor canal
Femoral triangle
