Objective To investigate the impact of continuous femoral nerve block (CFNB) combined with Celebrex and controlled intravenous analgesia (CIA) on the postoperative analgesic effects of total knee replacement. Methods 305 patients of ASA I-II who had received unilateral knee replacement in our hospital from June 2008 to December 2010 were divided into the CFNB combined with celebrex group (group A) with 122 patients and the CIA group (group B) with 183 patients. The pain scores and the dosage, times and adverse reactions of the two groups with 24 and 48 hours after surgery were observed and recorded. Results 24 and 48 hours after surgery, group A was significantly lower than group B in the ratios of patients with moderate and severe pain (P <0.01), but significantly higher than group B in the ratios of patients with mild and no pain (P < 0.01). 8.2% (10/122) of the patients in group A required supplementary analgesics due to postoperative pain, which was significantly lower than that in group B [25.1% (46/183)], with statistically significant differences (P <0.01). The incidence rate of nausea, vomiting, dizziness, drowsiness and other adverse reactions was 4.9% (6/122), which was significantly lower than that in group B [25.1% (46/183)], with statistically significant differences (P <0.01). Conclusion CFNB can provide more satisfactory analgesic effects than CIA for total knee replacement and causes fewer adverse reactions, thereby worthy of promotion and application.%目的 探讨连续股神经阻滞镇痛(CFNB)复合西乐葆与静脉镇痛(CIA)对全膝关节置换术患者术后镇痛效果的影响.方法选择我院2008年6月～2010年12月ASAⅠ～Ⅱ级行单侧膝关节置换术患者305例作为观察对象,根据术后采用的镇痛方式的不同分为CFNB复合西乐葆组(A组)122例与CIA组(B组)183例,观察并记录两组术后24、48 h的疼痛评分及使用其他止痛药的剂量、次数和不良反应.结果 术后24、48 h时A组中、重度疼痛患者比例明显低于B组(P <0.05),而轻度及无痛患者比例明显高于B组(P <0.05).A组术后患者因疼痛需要辅助镇痛药的占8.2%(10/122),显著低于B组[25.1%(46/183)],两组比较差异有高度统计学意义(P <0.01).A组术后第1天出现恶心、呕吐、头晕、嗜睡等不良反应发生率为4.9%(6/122),显著低于B组[13.7%(25/183)],两组比较差异有高度统计学意义(P <0.01).结论 CFNB可以为全膝关节置换术后患者提供比CIA满意的镇痛效果,且术后不良反应少,值得推广和应用.
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