连续股神经阻滞在初次全膝关节置换术后短期内多模式镇痛中的临床疗效分析

Clinical efficacy of continuous femoral nerve block in the short term multimodal analgesia management after total knee arthroplasty for the first time

摘要:

目的：比较连续股神经阻滞复合多模式镇痛（治疗组）和常规多模式镇痛（对照组）在初次全膝关节置换手术（total knee arthroplasty，TKA）围手术期的镇痛效果及术后6月膝关节功能评估的随访结果。方法：选取2011年10月至2012年10月因膝关节骨关节炎行TKA的患者48例，随机分成2组，每组24例（n=24）。治疗组和对照组分别给予２种方案作为术后镇痛方式。2组患者均采用全身麻醉方式。在围手术期，采用静息、被动、主动视觉模拟评分法观察患者的疼痛评分。观察术后膝关节活动度，相关并发症等指标。在术后6月随访时，根据膝关节学会评分系统对患者膝关节功能进行评估。结果：各项指标提示治疗组患者术后2 d内镇痛效果明显，术后不良反应及6月后膝关节功能２组无统计学差异。结论：连续股神经阻滞配合以多模式镇痛可以有效地缓解TKA患者术后早期疼痛，特别是48 h以内的急性疼痛，从而促进患者膝关节的早期功能恢复，但并不增加全身不良反应，是较为理想的镇痛方案。

Abstract:

Objective：To compare the analgesic effects between continuous femoral nerve block（CFNB） plus multimodal analgesia （experimental group） and normal multimodal pain controlled analgesia（control group） after total knee arthroplasty for the first time and to evaluate the knee function with six months’follow-up. Methods：From October 2011 to October 2012，48 patients undergoing unilateral total knee arthroplasty were randomly devided into experimental group and control group，24 cases for each group. Two postoperative analgesia methods were applied in two groups respectively and general anesthesia was used in both group. In the periop－erative period，rest，passive and initiative visual analogue scales were used to evaluate perioperative pain. The range of motion（ROM） and complications were observed and recorded. All patients were followed up for 6 months and knee society scoring system was used to assess knee function. Results：All index indicated that analgesia effect was more obvious in experiment group than in control group within 2 d after opertion. There was no significant difference in adverse reactions and ROM at 6 months after the operation（P ＞0.05）. Conclusion：CFNB combined with multimodal analgesia can alleviate the early pain for patients undergoing total knee arthroplasty，especially at 48 hours after operation without increasing adverse reactions． Therefore，it should be considered a better analgesia method for patients after total knee arthroplasty．