目的 观察超声引导下连续隐神经阻滞(SNB)联合多模式镇痛在膝关节置换术中的应用效果.方法 择期行单侧膝关节置换术患者60 例,男23 例,女37 例,年龄50~75 岁,采用数字表法随机分为两组:连续隐神经阻滞组(A 组)和连续股神经阻滞组(B 组).两组术前均行超声引导,神经阻滞单次给药0.5%罗哌卡因 25 ml,置入导管,接镇痛泵持续输入0.2%罗哌卡因.诱导后插入喉罩,术中静-吸复合全麻维持,术毕局部浸润麻醉.记录首次下地时间,行走距离,术后 12、24、48 h膝关节活动度及住院天数;记录补救镇痛药物用量及不良反应.结果 A组首次下地时间明显早于B组[(25.4±2.1)h vs (34.0±2.7)h],行走距离明显多于 B组[(7.6±1.8)步 vs (3.7±1.3)步,P<0.05];术后膝关节活动度 A 组明显大于 B 组[12 h:(75.8±4.3)°vs (65.4±4.7)°,24 h:(93.3±4.2)°vs (81.8±4.3)°,48 h:(102.1±4.1)°vs (95.1±2.6)°,P<0.05];且 A 组住院时间明显短于B组[(5.3±1.2)d vs (7.4±1.4)d,P<0.05];补救镇痛药物及恶心呕吐发生情况两组差异无统计学意义.结论 超声引导下连续隐神经阻滞联合多模式镇痛可以促进膝关节置换术后患者早期康复.%Objective To compare the effect of continuous saphenous nerve block (SNB)with femoral nerve block (FNB)under multimodal analgesia for early analgesic effect and rehabilitation af-ter total knee replacement (TKA).Methods Sixty patients scheduled to undergo TKA,23 males and 37 females,were randomly divided into two groups:group A (continuous SNB)and group B (contin-uous FNB ).The patients received PCA after surgery by the catheter placed near nerve with ultrasound-guided.The loading dose was 0.5% ropivacaine 25 ml and 0.1 mg epinephrine,back-ground dose was 5 ml/h,bolus dose was 5 ml and the locking time was 20 min.The first time to walk and total steps,the knee joint range of motion,postoperative hospital stay,general anesthetics and additional analgesics dose and the side effects were also recorded.Results The first time to walkand walking distancein group A were better than group B [(25.4±2.1)h vs (34.0±2.7)h,(7.6±1.8) steps vs (3.7±1.3)steps,(P<0.05)].The range of motion in group A was bigger than in group B [12 h:(75.8±4.3)°vs (65.4±4.7)°,24 h:(93.3±4.2)°vs (81.8±4.3)°,48 h:(102.1±4.1)° vs (95.1±2.6)°,P<0.05].The average length of postoperative hospital stay was shorter in group A than in group B [(5.3±1.2)d vs (7.4±1.4)d,P<0.05].The additional analgesics and the side effects were similar between the two groups.Conclusion The continuous SNB combined with multi-modal analgesia was more beneficial to patients with the early postoperative rehabilitation for TKA.
展开▼
