收肌管阻滞技术在初次全膝置换术后早期镇痛中的应用研究

目的探讨收肌管阻滞术在全膝关节置换术术后疼痛管理及早期康复中的作用。 方法前瞻性选取于哈尔滨医科大学附属第一医院骨科行初次行单侧全膝关节置换术(TKA)的患者40例，随机分为收肌管阻滞联合帕瑞昔布镇痛组20例及单纯帕瑞昔布镇痛组20例。纳入初次单侧TKA患者，排除严重感染和精神疾病等患者。收肌管阻滞置管术后立即执行。两组患者围手术期观察术后不同时间点的静息与活动状态下视觉模拟评分、股四头肌肌力、膝关节活动范围、住院天数及有无并发症发生。所得数据通过独立样本t检验、非参数Wilcoxon秩和检验以及卡方检验进行分析。 结果与单纯应用帕瑞昔布相比，联合应用收肌管阻滞技术能够有效地降低患者术后早期VAS评分(术后6 h～72 h活动VAS：Z＝－3.124、－2.157、－2.044、－2.467、－2.471，P <0.05；术后6 h～24 h静息VAS：Z＝－2.310、－2.409、－2.208，P<0.05)。在膝关节活动度与术后住院时间上两组差异无统计学意义(P>0.05)。且收肌管阻滞组患者体现出更好的康复依从性，未出现因操作引起的并发症。 结论全膝关节置换术术后辅助收肌管阻滞术能够有效地缓解患者术后疼痛，有助于患者早期开展功能锻炼与快速康复。

Adductor canal blockade for early post-operative pain analgesia after primary total knee arthroplasty

ObjectiveTo evaluate the efficacy of adductor canal block(ACB) on pain management and early rehabilitation after total knee arthroplasty (TKA). MethodsA total of 40 patients undergoing primary unilateral TKA in the first affilicated hospital of Harbin Medical University were randomly divided into two groups: ACB combined with parecoxib group (test group) and only parecoxib group (control group). Primary TKA patients were included, and the patients with severe infection or mental diseases were excluded. Adductor canal block was immediately performed. Perioperative data was calculated for statistical analysis.The data were analyzed with independent-samples t test, non-parameters Wilcoxon symbols test and chi-square test. ResultsComparing the test group with the control group, significant differences were found in rest pain, activity pain in early stage postoperatively (postoperative 6 h~72 h active VAS: Z= -3.124, -2.157, -2.044, -2.467, -2.471, all P < 0.05; postoperative 6 h~24 h rest VAS: Z=-2.310, -2.409, -2.208, P<0.05). No difference was found in knee function and length of hospital stay between two groups(P>0.05). The patients in the test group showed better compliance of rehabilitation. Further more, no ACB complication was found. ConclusionACB can effectively alleviate postoperative pain in TKA patients, and it could be helpful for fast functional recovery.