连续腰丛神经阻滞与股神经阻滞在全膝关节置换术后镇痛中的临床研究

目的:比较连续腰丛神经阻滞与股神经阻滞在全膝关节置换术后镇痛中应用效果.方法:选择行全膝关节置换手术病人74例.按照随机数字表法将病人随机分为连续股神经阻滞组和连续腰丛神经阻滞组,各37例.记录术后4、8、16、32 h静息时及术后16、32 h活动时视觉模拟评分法(VAS)评分;应用美国特种外科医院膝关节评分法对术前、术后2周以及术后10周膝关节功能进行评分;记录2组不良反应情况.结果:连续腰丛神经阻滞组术后4、8、16、32 h静息时VAS评分及术后16、32 h活动时VAS评分均低于连续股神经阻滞组(P<0.05～P<0.01);2组术后2周与术后12周美国特种外科医院膝关节评分均较术前明显升高(P<0.01);连续股神经阻滞组不良反应率37.84％,高于连续腰丛神经阻滞组的16.22％(P<0.05).结论:全膝关节置换术后镇痛连续腰丛神经阻滞组明显优于连续股神经阻滞组,且不良反应较轻,具有重要临床意义.

Comparative study of the postoperative analgesia between continuous lumbar plexus block and femoral nerve block in total knee replacement

Objective:To compare the effects of postoperative analgesia between continuous lumbar plexus block and femoral nerve block in total knee replacement. Methods:Seventy-four patients treated with total knee replacement surgery from December 2014 to September were randomly divided into the continuous femoral nerve block group and continuous lumbar plexus block group ( 37 cases each group). The scores of VAS of resting after 4 h,8 h,16 h and 32 h of operation,and acting after 16 h and 32h of operation in two groups were recorded. The scores of knee joint function in two groups before operation and after 2 weeks and 10 weeks of operation were evaluated. The incidence rates of adverse reaction in two groups were recorded. Results:The scores of VAS of resting after 4 h,8 h,16 h and 32 h of operation,and acting after 16 h and 32 h of operation in continuous lumbar plexus block group were significantly lower than those in continuous femoral nerve block group(P<0. 05 to P<0. 01). Compared before operation,the HSS scores of preoperative 2 weeks and 12 weeks in two groups significantly increased(P<0. 01). The incidence rate of adverse reaction in continuous femoral nerve block group(37. 84％) was significantly higher than that in continuous lumbar plexus block group(16. 22％) (P < 0. 05). Conclusions:The effect of continuous lumbar plexus block group on postoperative analgesia in knee replacement is better than that of the continuous femoral nerve block,the adverse reaction of which is light,which has important clinical significance.