神经阻滞在膝关节置换术后镇痛的应用研究

目的全膝关节置换术(TKA)是治疗终末期膝关节骨关节炎和类风湿性关节炎的最有效方法，而术后疼痛管理效果是直接影响患者功能康复的重要因素之一。因此，本研究试图探索股神经阻滞(FNB)联合膝关节周围局部浸润阻滞(PAI)在TKA术后早期的镇痛效果，并讨论分析其临床应用价值及前景。 方法根据纳入标准及排除标准，回顾性纳入2018年10月8日至2019年2月8日因骨关节炎和类风湿性关节炎在关节病院骨坏死与关节重建病区行TKA的126例患者，接受PNB＋PAI者为实验组，接受FNB＋内收肌管阻滞(ACB)者为对照组，每组63例，所有患者的手术均由同一术者完成。分别采用t检验比较两组患者术前、术后6、12、24、48、72 h膝关节视觉模拟疼痛评分(VAS)、阿片类药物用量及膝关节活动度(ROM)，采用卡方检验比较两组恶心呕吐发生率。 结果两组患者术前人口学特征及术前VSA评分差异无统计学意义(P>0.05)，所有患者均随访72 h。术后6、12、24 h实验组VAS评分低于对照组(t＝3.232、2.946、3.146，P<0.05)，术后48、72 h两组VAS评分差异无统计学意义(t ＝0.527、1.108、P>0.05)，术后24 h实验组膝关节活动度优于对照组(t＝3.082，P<0.05)，术后48、72 h两组患者膝关节活动度(t＝0.543、0.902，P>0.05)、阿片类药物用量(t＝0.857，P>0.05)、恶心呕吐发生率(χ²＝52.29，P>0.05)在两组差异无统计学意义，两组患者均未出现股四头肌无力、局部血肿等不良并发症。 结论FNB＋PAI在TKA术后早期疼痛管理中效果确切，同FNB＋ACB相比，在术后24 h内的镇痛作用及膝关节活动度更优，因此，该方法可以作为FNB＋ACB的替代方法，并可以在TKA中推广应用。

Clinical study of application of nerve block in early analgesia after total knee replacement

ObjectiveTo observe the analgesia effects of femoral nerve block(FNB)combined with periarticular injection(PAI) in early postoperation after total knee replacement (TKA), and analyze its clinical application value and prospect. MethodsA total of 126 patients(126 knees) were retrospectively included in this study according to inclusion criteria and exclusion criteria, who accepted TKA from October, 2018 to February, 2019.The patients were divided into the experimental group who accepted FNB+ PAI(n=63) and the control group who accepted FNB+ ACB(n=63). All the surgeries were completed by one experienced doctor. The results of visual analogue score(VAS), opioid consumption(using t test), the incidence of nausea and vomiting, and the knee range of motion(ROM) were compared between the two groups before and at six, 12, 24, 48 and 72 h after surgery(using chi-square test). ResultsThere was no statistical difference between the two groups on preoperative demographic characteristics and preoperative VSA score (P>0.05). VAS scores in the experimental group were lower than those in the control group at six, 12, 24 h after surgery(t=3.232, 2.946, 3.146, P<0.05), and had no statistical difference at 48, 72 h after surgery(t=0.527, 1.108, P>0.05). The knee ROM in experimental group was better than that in control group at 24 h after surgery(t=3.082, P<0.05), and had no difference at 48, 72 h after surgery(t=0.543, 0.902, P>0.05). The opioids consumption(t=0.857, P>0.05), the incidence of nausea and vomiting (χ²=52.29, P>0.05) were the same in both groups. None of the patients occurred quadriceps weakness, nor the local hematoma complications. ConclusionWhen compared with FNB+ ACB, FNB+ PAI is an effective method in early postoperative analgesia therapy after TKA, with better pain and wide ROM at 24 h after surgery, which can be an alternative method for FNB+ ACB.