胫骨骨折术后超声引导下收肌管阻滞与股神经阻滞的镇痛效果比较

【目的】探讨超声引导下收肌管阻滞与股神经阻滞用于胫骨骨折术后镇痛的效果。【方法】选取本院收治的胫骨骨折患者80例,按镇痛方案不同分为观察组(n=47)和对照组(n=33),对照组予超声引导下股神经阻滞镇痛,观察组予超声引导下收肌管阻滞,对比两组的镇痛镇静效果、股四头肌肌力及不良反应率。【结果】两组屈膝及静息时术后12 h、24 h、48 h VAS评分均小于术后8 h和术后4 h(P<0.05),而两组间同一时间屈膝及静息时VAS评分比较差异无统计学意义(P>0.05)。两组术后8 h、12 h、24 h Ramsay评分均低于术后4 h(P<0.05),两组间同一时间Ramsay评分比较差异无统计学意义(P>0.05)。对照组股四头肌肌力:术前〉术后24 h>术后48 h(P<0.05),观察组无明显变化(P>0.05);观察组术后24 h、术后48 h肌力均大于对照组(P<0.05)。观察组不良反应发生率为19.15%(9/47),显著低于对照组的42.42%(14/33),其差异具有统计学意义(X2=5.127,P<0.05)。【结论】超声引导下收肌管阻滞与股神经阻滞术后镇痛、锿静效果相当,但收肌管阻滞镇痛更为迅速、对股四头肌肌力影响较小,更有利于术后早期康复治疗,安全性更高。

Effect of Ultrasound-guided Adductor Tube Block and Femoral Nerve Block for Postoperative Analgesia of Tibial Fractures

Objective]To investigate the ffct of ultrasound-guided adductor block and femoral nerve block for postoperative analgesia of tibial fracture.Methods]A total of 80 patients with tibial fracture in our hospital were selected and divided into observation group(1=47)and control group(n=33)according to different analgesic schemes.The control group was given ultrasound guided femoral nerve block analgesia.and the observation group was given ultrasound-guided adductor canal block.The analgesic and sedative ffect,.quadriceps muscle strength and adverse reaction rate of the two groups were compared.Results]At 12 h,24 h and 48 h after operation,the VAS scores of the two groups when bending the knee and at rest were lower than thoseat8 h and 4 h after operation(P<0.05).There was no significant difference in VAS score between the two groups at the same time when bending the knee and at rest(P>0.05).Ramsay scores at 8 h.12 h and 24 h after operation in the two groups were lower than those at 4 h after operation(P<0.05).There was no significant difference in Ramsay scores between the two groups at the same time(P>0.05).The muscle strength of quadriceps femoris in the control group:preoperative>24 h after operation>48 h after opera-tion(P<0.05).there was no significant change in the observation group(P>0.05);the muscle strength of the observation group 24 h and 48 h after operation were greater than those of the control group(P<0.05).The incidence of adverse reactions in the observation group was 19.15%(9/47),which was significantly lower than 42.42%(14/3)in the control group,and the difference was stitically significant(χ²=5.127.P<0.05).Conclusion]Ultrasound guided adductor block has the same analgesice and sedative efeets as femoral nerve block.but adductor block is more rapid in analgesia,has less efect on quadriceps muscle strength,and is more conducive to early postoperative rehabilitation treatment with higher safety.