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上海市卫生健康委员会
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多模式镇痛在全膝关节置换术术后镇痛中的应用
Effects of a new multimodal perioperative analgesic regimen in patients after Total knee arthroplasty surgery

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DOI:
作者:
裘毅敏 黄小静 黄丽娜 陈敏 汪正平 李士通
QIU Yimin, HUANG Lina, HUANG Xiaojing, CHEN Min, W
作者单位:
上海交通大学附属第一人民医院
Department of Anesthesiology and Pain Management, Shanghai First People’s hospital, Shanghai Jiaotong University
关键词:
全膝关节置换术 多模式镇痛 神经刺激器 周围神经阻滞
Multi-mode analgesia; Total knee Arthroplastic Surgery; Nerve Stimulator; Peripheral nerve block
摘要:
目的 观察静脉自控镇痛复合坐骨神经阻滞、股神经阻滞、局麻药膝关节局部浸润的多模式镇痛方法用于全膝关节置换术后镇痛的临床效果。方法 ASA Ⅰ～Ⅱ级行单侧全膝关节置换的患者60例，随机分为两组：多模式镇痛组(实验组，n=30)和持续静脉自控镇痛组(对照组，n=30)。两组患者均维持镇痛2d，记录术后2h、24h、48hVAS疼痛评分，术后静脉镇痛PCIA按压数，下肢运动功能阻滞程度、被动及主动膝关节屈曲角度、术后最早下床功能锻炼时间以及住院天数。结果 实验组在术后2h、24h静息状态的疼痛VAS评分<4分的构成比均显著大于对照组（P 值均<0.01），实验组在术后24h、48h运动状态的疼痛VAS评分<4分的构成比均显著大于对照组（P 值均<0.01）；两组患者的术后24h、48h未见患肢运动阻滞；与对照组相比，实验组术后PCIA按压数明显减少（P <0.01）；术后膝关节屈曲度明显增大（P <0.01）；下床活动时间缩短（P <0.01）；同时住院时间缩短（P <0.01）。结论 静脉自控镇痛复合局麻药膝关节局部阻滞、坐骨神经阻滞、股神经阻滞的多模式镇痛方法用于全膝关节置换术后镇痛的效果良好,下肢肌力影响轻微，并发症少，是全膝关节置换术后较为理想的镇痛方法。
Objective To evaluate the clinical effect of multi-mode analgesia method including patient-controlled intravenous analgesia(PCIA) combined with sciatic nerve block, femoral nerve block analgesia and local block around the knee joint after total knee arthroplasty(TKA). Methods Sixty patients with American Society of Anesthesiologists(ASA) I-II were scheduled for unilateral TKA and randomly divided into multi-mode analgesia method group(test group) and patient controlled intravenous analgesia group (control group).There were 30 patients in each group. Two groups of patients were maintained analgesic for 2 days. The visual analog scores (VAS),the total press times of PCIA, the block degree of limb motor function, the angle of passive and active knee flexion, the time of first function exercise after sugery, and the days in hospital were recorded 2h, 24h and 48 h postoperatively.Results The number of the patients with static VAS<4 in test group were much more than those in control group at 2h,24h time points. The number of the patients with dynemic VAS<4 in test group were much more than those in control group at 24h,48h time points. the total press times of PCIA were significantly less in the test group than those in the control group (P <0.01); no suffering from limb dynemic block in two groups were observed;compared with control group,the degree of knee flexion were obviously increased(P<0.01); the time of first function exercise after sugery were shortened (P<0.01); the days in hospital were shortened in test group (P<0.01). Conclusions Multi-mode analgesia method including patient controlled intravenous analgesia(PCIA) combined with sciatic nerve block, femoral nerve block and local block around the knee joint on analgesia after total knee arthroplasty(TKA) can relieve pain effectively, weak the muscle strength of lower limbs slightly, decrease the side effects associated with opioids after TKA, and is an ideal method of analgesia for TKA.

 

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