摘要
目的探索连续收肌管阻滞(CACB)联合腘动脉与膝关节后囊间隙浸润(IPACK)阻滞或联合坐骨神经阻滞(SNB)对行全膝关节置换术(TKA)的患者术后运动功能恢复的影响。方法选取拟行首次TKA患者42例,随机分为两组:CACB联合IPACK组(IPACK组)和CACB联合SNB组(SNB组),每组21例。全麻诱导前分别在超声引导下采用0.25%罗哌卡因行神经阻滞,IPACK组行收肌管阻滞(30 mL)和IPACK阻滞(30 mL),SNB组行收肌管阻滞(30 mL)和SNB(30 mL),两组均在收肌管内置管行连续镇痛。确认阻滞效果后行全麻诱导。记录患者术后首次下地站立时间,麻醉复苏室(PACU)内、术后MAX0~24 h、术后24 h、MAX24~48 h及术后48 h的静息时和活动时疼痛的数字评分(NRS)、改良Bromage评分、TUG试验、关节活动度(ROM)结果、股四头肌肌力、患者满意度及不良反应等。结果术后大部分时间内,两组患者静息或活动时NRS评分相当,但SNB组患者PACU内活动时NRS评分较低。IPACK阻滞患者术后首次下地时间明显缩短,在PACU内的改良Bromage评分以及术后24 h和术后48 h的膝关节主动屈曲角度(ROM)更优,术后第1天可进行TUG试验的患者数量也明显较多。术后两组患者股四头肌肌力、满意度、住院时间和不良反应之间的差异无统计学意义。结论CACB联合IAPCK阻滞用于TKA术后患者术后早期运动功能恢复更好,且镇痛效果不亚于CACB联合SNB,值得推广。
Objective To investigate the effect of continuous adductor canal block(CACB)combined with infiltration between the popliteal artery and capsule of the knee(IPACK)or with sciatic nerve block(SNB)on motor function recovery in patients undergoing total knee arthroplasty(TKA).Methods Forty-two patients scheduled for initial TKA were randomly assigned to two groups:the CACB combined with IPACK group(IPACK group)and the CACB combined with SNB group(SNB group),with 21 patients in each group.Before general anesthesia induction,ultrasound-guided nerve blocks were performed using 0.25%ropivacaine:the IPACK group received CACB(30 mL)and IPACK block(30 mL),while the SNB group received CACB(30 mL)and SNB(30 mL).Both groups underwent continuous analgesia via catheterization in the adductor canal.The effectiveness of the block was confirmed before anesthesia induction.Postoperative outcomes recorded included time to first ambulation,resting and active Numeric Rating Scale(NRS)pain scores at the Post-Anesthesia Care Unit(PACU),at MAX0-24h,24 h,MAX24-48h,and 48 h,modified Bromage scores,Timed Up and Go(TUG)test results,range of motion(ROM),quadriceps strength,patient satisfaction,and adverse events.Results Both groups showed comparable NRS scores at most time points during resting and activity;however,the SNB group had a lower NRS score during activity in the PACU.Patients in the IPACK group had significantly shorter time to first ambulation,better modified Bromage scores in the PACU,and superior ROM at 24 h and 48 h.Additionally,more patients in the IPACK group were able to complete the TUG test on postoperative day 1.There were no significant differences between the two groups in quadriceps strength,patient satisfaction,length of hospital stay,or adverse events.Conclusion CACB combined with IPACK block enhances early motor function recovery post-TKA and provides comparable analgesia to CACB combined with SNB.This approach is recommended for broader clinical application.
作者
朱彩艳
陈剑明
刘志恒
李俊杰
刘诗辉
白韬扬
邹吉鹏
刘友坦
ZHU Cai-yan;CHEN Jian-ming;LIU Zhi-heng;LI Jun-jie;LIU Shi-hui;BAI Tao-yang;ZOU Ji-peng;LIU You-tan(Department of Anesthesiology,Shenzhen Hospital of Southern Medical University,Shenzhen 518101,Guangdong,China;不详)
出处
《广东医学》
CAS
2024年第11期1457-1463,共7页
Guangdong Medical Journal
基金
广东省自然科学基金面上项目(2024A1515010810)
深圳市“医疗卫生三名工程”项目资助(SZSM202211007)
深圳市第二人民医院院级临床项目(20213357027)。
关键词
全膝关节置换术
连续收肌管阻滞
腘动脉与膝关节后囊间隙浸润阻滞
坐骨神经阻滞
运动功能恢复
total knee arthroplasty
continuous adductor canal block
infiltration between the popliteal artery and capsule of the knee
sciatic nerve block
motor function recovery
