超声引导下收肌管阻滞联合膝关节囊后间隙阻滞在全膝关节置换中的应用

目的观察超声引导下收肌管阻滞(ACB)联合膝关节囊后间隙(IPACK)阻滞在全膝关节置换(TKA)术中的应用效果。方法将60例初次单侧TKA手术患者按随机数字表法分为A组(采用ACB+IPACK阻滞镇痛,30例)和B组(采用股神经阻滞镇痛,30例)。记录术后不同时间点静息和活动状态下疼痛数字分级法(NRS)评分、股四头肌肌力、膝关节活动度、镇痛情况及不良反应发生率。结果术后12、24 h静息时和术后2、12、24、48 h活动时NRS评分A组均明显低于B组(P<0.05);术后2、12、24 h股四头肌肌力A组均明显大于B组(P<0.05);术后1、3、7、14 d时膝关节活动度A组均明显大于B组(P<0.05);术后48 h内镇痛自控泵按压次数、采用氟比洛芬酯补救镇痛例数、恶心发生率A组均明显少(低)于B组(P<0.05)。结论与股神经阻滞比较,超声引导下ACB+IPACK阻滞为TKA术后提供了更好的镇痛效果,减少了术后镇痛药用量,保留了股四头肌肌力,更利于患者术后恢复。

Application of ultrasound-guided adductor canal block combined with infiltration between the popliteal artery and capsule of the knee block analgesia in total knee arthroplasty

Objective To investigate the effect of ultrasound-guided adductor canal block(ACB)combined with infiltration between the popliteal artery and capsule of the knee(IPACK)block analgesia in total knee arthroplasty(TKA).Methods Sixty patients who underwent primary unilateral TKA were randomly divided into group A(30 cases received ACB plus IPACK block analgesia)and group B(30 cases received femoral nerve block analgesia).During resting and activity at different time points after operation,the numerical rating scale(NRS),quadriceps femoris muscle strength,knee range of motion,analgesia situation and adverse reactions rate were recorded.Results The NRS of group A was significantly lower than group B,during resting at 12,24 h postoperation and during activity at 2,12,24,48 h postoperation(P<0.05).At 2,12,24 h after surgery,the muscle strength of quadriceps femoris in group A was significantly greater than that in group B(P<0.05).Knee range of motion in group A was significantly greater than that in group B at 1,3,7,14 d postoperation(P<0.05).In 48 h after surgery,the pressing times of patient controlled analgesia,caes number of remedial analgesia with fluorobilofen,and the incidence rate of nausea in group A were significantly less(lower)than those in group B(P<0.05).Conclusions Compared with femoral nerve block alone,ultrasound-guided ACB plus IPACK provide better analgesia after TKA,which reduce postoperative analgesics dosage,retain the muscle strength of quadriceps femoris,and are beneficial to postoperative recovery.