摘要
目的探讨行择期全膝关节置换术(TKA)的患者不同入路收肌管阻滞的镇痛效果及对股四头肌运动功能的影响。方法选取择期行全身麻醉下单侧全膝关节置换术的患者90例,随机分为3组:近端收肌管组(A组)、中段收肌管组(B组)和远端收肌管组(C组),每组30例。麻醉诱导后,在超声引导下根据股动脉相对于缝匠肌的位置确定不同入路,单次给药0.375%罗哌卡因20ml进行收肌管阻滞,记录3组患者术后6h, 12h, 24h的静息视觉模拟评分(VAS)及术后24h活动时VAS评分、timed-up-and-go(TUG)测试时间和股四头肌肌力,记录术中舒芬太尼用量、术后辅助镇痛情况。结果 3组患者术后6h, 24h静息VAS评分比较,差异无统计学意义,A组术后12h静息VAS评分、术后24h活动时VAS评分明显小于C组,差异有统计学意义(P<0.05),B组与A组和C组在各时间点VAS评分差异无统计学意义。3组患者A组术后24h股四头肌肌力优于C组,差异有统计学意义(P<0.05)。结论超声引导下近端收肌管阻滞可为TKA的患者提供更为优异的镇痛效果,且对股四头肌肌力影响更小。
Objective To explore the analgesic effect of adductor tube block in patients undergoing elective total knee arthroplasty and its effect on the motor function of quadriceps femoris.Methods Ninety patients undergoing unilateral total knee arthroplasty under general anesthesia were randomly divided into three groups: proximal adductor tube group(group A),middle adductor tube group(group B) and distal adductor tube group(group C).After anesthesia induction, different approaches were determined according to the position of the femoral artery relative to the sartorius muscle under the guidance of ultrasound, and the adductor tube block was performed with a single administration of 0.375% ropivacaine 20 ml.The resting visual analogue scores of the three groups were recorded at 6 h, 12 h and 24 h after operation, the VAS score during activity, timed-up-and-go test time and quadriceps muscle strength at 24 h after operation, the dosage of sufentanil during operation, postoperative auxiliary analgesia, and the adverse reactions such as puncture site infection, puncture site hematoma, local anesthetic poisoning and peripheral nerve injury were recorded in the three groups.Results There was no significant difference in resting VAS score between the three groups at 6 h and 24 h after operation, the resting VAS score at 12 hours after operation and the VAS score during activity at 24 hours after operation in group A were significantly lower than those in group C,the difference was statistically significant(P<0.05),there was no significant difference in VAS score between group B,group A and group C at each time point.The muscle strength of quadriceps femoris in group A was better than that in group C at 24 hours after operation, and the difference was statistically significant(P<0.05).Conclusion Ultrasound-guided proximal adductor tube block can provide more excellent analgesic effect for patients with total knee arthroplasty, and has less effect on the muscle strength of quadriceps femoris, so it is worth popularizing clinical
作者
刘阳
贾晓童
吕蒙
谷长平
王月兰
LIU Yang;JIA Xiaotong;LV Meng;GU Changping;WANG Yuelan(Department of Anesthesiology,Weifang Medical University,Weifang 261053,China;Department of Anesthesiology and Perioperative Medicine,the First Affiliated Hospital of Shandong First Medical University)
出处
《潍坊医学院学报》
2021年第3期217-219,240,共4页
Acta Academiae Medicinae Weifang
关键词
全膝关节置换
收肌管阻滞
超声引导
术后镇痛
Total knee arthroplasty
Adductor canal block
Ultrasound guidance
Postoperative analgesia
