股神经和硬膜外自控镇痛在全膝关节置换后的作用

背景：全膝关节置换后疼痛是阻碍早期锻炼的主要问题,置换后镇痛有多种方法可供选择,每种镇痛方法均有自身的优缺点,越来越多的学者趋向于神经阻滞和自控镇痛。目的：比较经股神经自控镇痛和硬膜外自控镇痛在单侧全膝关节置换后镇痛及促进功能恢复效果的差异。方法：选择ASAⅠ~Ⅲ级单侧膝关节置换患者42例,随机分为股神经自控镇痛组和硬膜外自控镇痛组,每组21例,均在连续硬膜外麻醉下实施置换,置换后连接镇痛泵。置换后4,8,12,24和48 h,采用目测类比法进行疼痛评分,采用Bromage评分法进行运动阻滞评分;分别记录患者在置换后1,2,3 d、1周、1个月患膝关节主动活动的关节活动度以及不良反应发生情况等。结果与结论：全膝关节置换后两组目测类比评分差异无显著性意义,运动阻滞Bromage评分股神经自控镇痛组低于硬膜外自控镇痛组,而且股神经自控镇痛组不良反应明显低于硬膜外自控镇痛组,早期关节活动度也好于硬膜外自控镇痛组。提示股神经自控镇痛在全膝关节置换后的镇痛效果是安全有效的,有利于置换后功能恢复。

Patient-controlled femoral nerve analgesia and epidural analgesia for postoperative pain after total knee arthroplasty

BACKGROUND: Postoperative pain is the main hindrance to joint function rehabilitation, and most clinicians prefer controlled femoral nerve analgesia and epidural analgesia.OBJECTIVE:To evaluate the therapeutic effect of patient-controlled femoral nerve analgesia (PCFNA) and epidural analgesia (PCEA) on postoperative pain and functional rehabilitation after total knee arthroplasty. METHODS:Forty-two patients undergoing unilateral total knee arthroplasty were randomly divided into group PCFNA and group PCEA．All patients received unilateral spinal anesthesia. Visual analogue scale (VAS) pain scores and Bromage scores were recorded at each time point of 4, 8, 12, 24 and 48 hours. And the range of motion (ROM) and adverse effects were recorded at the time point of 1 day, 2 days, 3 days, 1 week and 1 month. RESULTS AND CONCLUSION:No statistical significance was found in the VAS pain score．The Bromage scores in group PCFNA were obviously lower than those in group PCEA and the ROM was better in group PCFNA than the group PCEA. Femoral nerve analgesia effects on postoperative pain after total knee arthroplasty are secure and effective.