神经阻滞在全麻下全膝关节置换术中的应用

目的:评价股神经-坐骨神经阻滞用于全麻下老年患者全膝置换术的效果。方法:2017年7月至2019年7月择期单侧全膝置换术患者60例,其中男35例,女25例;年龄66～74(70.2±10.3)岁;BMI 18～25(21.3±3.5) kg/m²;病程2～3(1.2±0.3) d。分为全麻组30例和全麻加神经阻滞组30例。全麻加神经阻滞组于麻醉诱导前采用超声引导下行患侧股神经-坐骨神经阻滞,0.5%罗哌卡因股神经穿刺点注入20～25 ml,坐骨神经穿刺点注入15～20 ml,总量不超过40 ml。术后两组行术后静脉镇痛治疗。记录患者单位时间内丙泊酚和瑞芬太尼用量。术后48 h随访,记录两组术后恶心呕吐和术后瞻妄的发生情况,VAS>3分时静脉注射曲马多2 mg/kg,记录两组曲马多的追加次数。术后48 h时行患者满意度评分,记录患者的住院时间。结果:与全麻组比较,全麻加神经阻滞组患者丙泊酚和瑞芬太尼用量降低,术后恶心呕吐发生率及曲马多追加次数降低,患者满意度升高(P<0.05),两组患者住院时间的比较差异无统计学意义(P>0.05)。两组患者治疗后...

Application of nerve block in total knee arthroplasty under general anesthesia

Objective: To evaluate the effect of femoral and sciatic nerve block in total knee replacement of elderly patients under general anesthesia. Methods: From July 2017 to July 2019,60 patients with unilateral total knee replacement were selected,including 35 males and 25 females; aged 66 to 74(70.2±10.3) years;BMI 18 to 25 (21.3 ±3.5) kg/m2;course 2 to 3 (1.2±0.3) days. The patients were divided into general anesthesia group(G group) 30 cases and general anesthesia plus nerve block group(GNB group) 30 cases. In GNB group,the femoral nerve sciatic nerve block was guided by ultrasound before anesthesia induction,20 to 25 ml was injected into the femoral nerve puncture point with 0.5% ropivacaine,15 to 20 ml was injected into the sciatic nerve puncture point,and the total volume was no more than 40 ml. Postoperative intravenous analgesia (PCIA) was performed in two groups. The dosage of propofol and remifentanil was recorded. Forty-eight hours after operation,the incidence of postoperative nausea and vomiting(PONV) and postoperative farsightedness were recorded. When VAS>3,tramadol 2 mg/kg was injected intravenously,and the additional times of tramadol were recorded. Forty-eight hours after operation,patients'' satisfaction score was used to record the length of stay. Results: Compared with group G,the dosage of propofol and remifentanil decreased,the incidence of PONV and the number of additional tramadol decreased,and the patients'' satisfaction increased (P<0.05). There was no significant difference in the length of stay between two groups (P>0.05). The ROM and HSS scores of two groups after treatment were higher than those before treatment (P<0.05),and the VAS scores were lower than those before treatment(P<0.05). There was no significant difference in ROM,VAS scores and HSS scores between two groups before treatment(P>0.05). The ROM and HSS scores of the GNB group after treatment were higher than those of the G group(P<0.05),and the VAS scores were lower than those of the G group(P<0.05). Conclusion: The application of femoral sciatic nerve block in total knee replacement under general anesthesia in elderly patients has good postoperative analgesic effect,and can reduce the dosage of general anesthesia,reduce PONV,and increase patient satisfaction.