超声引导下持续收肌管阻滞镇痛在膝关节僵直手法松解术后早期康复治疗中的应用

目的评价超声引导下持续收肌管置阻滞镇痛在膝关节僵直手法松解术后早期康复治疗中的应用效果。方法选择全膝关节置换术（TKA）术后关节僵直的患者36例，年龄45～75岁，体质指数18～25 kg/m2，ASAⅡ～Ⅲ级。所有患者均在静脉麻醉下由同一外科医生行手法松解术，而后在超声引导下行神经置管持续阻滞镇痛，置管成功后连接电子自控性输注泵行术后镇痛。根据神经阻滞镇痛方式不同，分为两组：持续收肌管阻滞镇痛组（A组）及持续股神经阻滞镇痛组（F组），每组18例。记录两组术后72 h内不同的观察点持续主动及被动运动功能锻炼时VAS评分、补救镇痛药物使用次数、术后12、24、36、48、72 h的膝关节活动度（range of motion，ROM）、住院时间及患者满意度等。观察镇痛期间恶心、呕吐、导管阻塞、渗液、脱管等并发症的发生情况。结果两组术后72 h镇痛期间不同时间点VAS评分、镇痛药物使用总次数及膝关节活动度比较差异无统计学意义（P＞0.05）；A组股四头肌力测试评分高于F组（P＜0.05），住院时间短于F组（P＜0.05），患者满意度高于F组（P＜0.05），阻塞、渗液等置管并发症发生率低于F组（P＜0.05）。结论膝关节僵直手法松解术后超声引导下持续收肌管阻滞镇痛与持续股神经阻滞镇痛均可获得较好的镇痛效果，但持续收肌管阻滞镇痛可有效保持股四头肌肌力，有利于早期主动功能锻炼，同时，置管的并发症发生率低，患者的满意度较高，为膝关节僵直手法松解术后康复治疗理想镇痛选择方式之一。

Ultrasound-guided continuous adductor canal block in early postoperative rehabilitation after ankylosis of knee joint with manual arthrolysis: a randomized controlled study

Objective To evaluate ultrasound-guided continuous adductor canal block in early postoperative rehabilitation after ankylosis of knee joint with manual arthrolysis. Methods Thirty-six patients (aged from 45 to 75 years, ASA physical status Ⅱ-Ⅲ) suffering from ankylosis of knee join after total knee replacement (TKA) received manual arthrolysis under intravenous general anesthesia. The continuous peripheral nerve block were performed and electronic controlled infusion pump was used for postoperative analgesia after successful catheterization. All the patients were randomly allocated into Group A (continuous adductor canal block) and Group F (continuous femoral nerve block) according to different nerve block (n=18). The visual analogue score (VAS) and the using times of rescue analgesic were recorded during active and passive movement function exercise 72 hours after operation. The range of motion (ROM) of knee were recorded 12 h, 24 h, 36 h, 48 h and 72 h after operation. The complications of catheterization, such as nausea, vomiting, catheter obstruction, drainage and the falling off the tube, and also patients′satisfaction were recorded during analgesia. Results The VAS sores, the using times of rescue analgesic and the ROM showed no statistical significance in 72 h between the two groups (P>0.05). The scores of quadriceps strength in Group A was significantly higher than that of Group F (P<0.05). Compared with Group F, the hospital stays was significantly shorter in Group A, with significant higher satisfaction (P<0.05). The incidence of catheterization complications such as catheter obstruction and drainage in Group A was significantly lower than that of Group F (P<0.05). Conclusion Both of continuous adductor canal block and continuous femoral nerve block can obtained effective analgesia in ankylosis of knee joint with manual arthrolysis, but the continuous adductor canal block can keep quadriceps muscle strength better, thereby improves early postoperative mobilization and reduces the incidence of catheterization complications with higher patients′satisfaction. It is an ideal options for postoperative rehabilitation of ankylosis of knee joint.