股神经和硬膜外自控镇痛在全膝关节置换术后的效果比较

目的：比较股神经和硬膜外自控镇痛在膝关节置换术后的效果和副作用。方法：选择ASAⅠ～Ⅱ级行单侧膝关节置换术患者50例,随机分为股神经自控镇痛组（PCFNA,n=25）和硬膜外自控镇痛组（PCEA,n=25）。均在单侧蛛网膜下腔阻滞麻醉下施术,术后通过留置导管连接0.2%罗哌卡因、2μg/mL芬太尼止痛泵镇痛。结果：两组在术后各时点静息VAS和吗啡用量、副作用的发生率无统计学差异。PCFNA组持续被动功能训练时的VAS疼痛评分均明显低于PCEA组患者（P〈0.01）;PCFNA组术后24h患肢股四头肌的肌力略低,非手术侧肌力略高（P〈0.000）。结论：股神经自控镇痛在持续被动运动镇痛效果优于硬膜外自控镇痛,不影响非手术侧股四头肌肌力,有利于早期下床活动。

Effect of Patient Controlled Femoral Nerve Analgesia and Patient Controlled Epidural Analgesia for Postoperative Pain after Total Knee Arthroplasty

Objective To compare the ettect of patient controlled femoral nerve analgesia （PCFNA） and patient controlled epidural analgesia （PCEA） on postoperative pain after total knee arthroplasty （TKA）. Methods Fifty patients undergoing unilateral TKA were randomly divided into two groups： group PCFNA and group PCEA. All patients received unilateral spinal anesthesia with 0.5% dicaine. Patients were given analgesia with 0.2% Ropivacaine and 2μg/ ml fentanyl after the operatopn. VAS pain scores at each time point during rest and continuous passive movements （CPM） were recorded. The muscle strength grades of quadriceps femoris and complications were compared. Results The VAS pain scores during rest, the consumption of morphine and CPM in group PCFNA were obviously lower than those femoris about the operated leg at postoperative 24th h in the incidence of side effects were comparable. The VAS scores of in group PCEA. Average muscle strength grades of quadriceps group PCFNA were lower than those in group PCEA, but higher about the non-operated leg. Conclusion After TKA surgery, the PCFNA can provide better pain relief especially at CPM. Slight impact on muscle strength of non-operated limb. Therefore, it should be another good option of analgesia after TKA.