不同途径硫酸镁注射联合脊髓麻醉在 膝关节镜手术中的应用

目的探讨膝关节镜手术中脊髓麻醉联合不同途径硫酸镁给药的止痛效果和可能的副作用。方法纳入2017年1月-2017年8月在该院接受膝关节镜手术的患者120例,将患者随机分为4组(每组30例),A组(对照组)仅鞘膜内注射布比卡因;B组(硫酸镁鞘内给药组)鞘内同时注射50.00 mg硫酸镁与布比卡因;C组(硫酸镁静脉给药组)鞘内注射布比卡因10 min后,在10 min内静脉注射100.0 ml生理盐水稀释的30.00 mg/kg硫酸镁,然后将10.00 mg/kg硫酸镁静脉滴注1 h;D组(硫酸镁关节内给药组)手术结束前10 min关节内注射用12.0 ml生理盐水(0.90%NaCl)稀释的800.00 mg硫酸镁。手术时间用分钟计算,记录主动和被动活动视觉模拟评分(VAS)、手术结束至能进行膝关节屈曲的时间、术后首剂止痛药的给药时间和用量,并记录患者血液动力学变化和出现的任何副作用。结果术后能够进行膝关节屈曲的时间、术后第一次镇痛时间及术后24 h哌替啶消耗量,关节内给药组明显优于其他组(P 0.05)。静脉给药组术后首剂镇痛药使用的时间(P=0.000)和术后24 h内哌替啶用量(P=0.000)明显优于鞘内给药组和对照组。关节内给药组休息和被动运动时VAS评分均低于其他3组(P=0.001)。结论硫酸镁关节内注射在膝关节镜术后镇痛过程中的效果优于静脉内注射和鞘内注射。

Application of different routes of co-administration of magnesium sulphate combined with spinal anesthesia in knee arthroscopic surgery

Abstract: Objective To compare the analgesic effect and possible side effects of different routes of magnesium sulphate administration in cases of spinal anesthesia for knee arthroscopy. Methods 120 patients scheduled for knee arthroscopy 4 groups (30 patients in each): group A received only Bupivacaine intrathecally; group B received 50.00 mg Mg sulphate with Bupivacaine intrathecally; Group C: after 10 min intrathecal injection of Bupivacaine, received intravenous injection of 30.00 mg/kg Mg sulphate in 100.0 ml saline within 10 min then 10 mg/kg Mg sulphate intravenous drip for one hour; Group D received intra-articular injection of 800.00 mg Mg sulphate diluted in 12.0 ml normal saline (0.90% NaCl) 10 min before the end of surgery. The operating time is in 10 minutes, record active and passive VAS, the time from the end of surgery to the knee flexion, time and dosage of the first analgesic after operation, hemodynamic changes and any possible side effects. Results The time of the knee flexion after surgery, the time and dose of the first analgesic after surgery and the consumption of Pethidine at 24 h after surgery, group D is significantly better than the other groups (P < 0.05) respectively. Group C is significantly better than group B and group C as regards time taken from end of surgery until first analgesic dose (P = 0.000) and as regards amount of pethidine consumption in first postoperative 24 h (P = 0.000). VAS at rest and with passive movement in group D is significantly lower other groups (P = 0.000). Conclusion Intraarticular administration of magnesium sulphate is found to be better than intravenous magnesium and intrathecal in postoperative analgesia.