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| 超声引导下不同入路连续隐神经阻滞在膝关节镜术后镇痛效果中的比较 |
| Comparison of ultrasound-guided continuous saphenous nerve blocks with different approaches for postoperative analgesia after knee arthroscopy |
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| DOI：10.12089/jca.2019.03.015 |
| 中文关键词: 膝关节镜 隐神经阻滞 超声引导 术后镇痛 |
| 英文关键词: Knee arthroscopy Saphenous nerve block Ultrasound-guided Postoperative analgesia |
| 基金项目: |
| 作者 | 单位 | E-mail | | 王丽 | 110016,沈阳市,北部战区总医院麻醉科 | | | 赵石磊 | 110016,沈阳市,北部战区总医院麻醉科 | | | 西志梦 | 110016,沈阳市,北部战区总医院麻醉科 | | | 张铁铮 | 110016,沈阳市,北部战区总医院麻醉科 | | | 刁玉刚 | 110016,沈阳市,北部战区总医院麻醉科 | diao72@163.com |
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| 中文摘要: |
目的 评价超声引导下不同入路连续隐神经阻滞在膝关节镜术后镇痛中的应用效果和对运动能力的影响。
方法 选择择期行全身麻醉膝关节镜手术患者48例，男42例，女6例，年龄25~33岁，体重65~81 kg，BMI 18.1~26.4 kg/m2，ASA Ⅰ或Ⅱ级。采用随机数字表法分为收肌管阻滞组（MG组）和大腿远端阻滞组（DG组），每组24例。患者麻醉诱导前均行超声引导下隐神经阻滞。MG组将导管置入收肌管间隙；DG组将导管置入隐神经周围约3 cm。两组均用超声定位导管位置，连接电子自控镇痛泵，镇痛泵设置两组相同。单次给药0.5%罗哌卡因+1%利多卡因20 ml，连接镇痛泵持续输入0.2%罗哌卡因。记录两组患者神经阻滞成功率，阿片类（舒芬太尼、瑞芬太尼）药用量，术后辅助镇痛情况，术后6、12、24 h 静息时VAS评分和timed-up-and-go测试时间，记录术后24 h穿刺部位血肿、周围神经损伤、局麻药中毒、穿刺部位感染发生情况。
结果 两组患者神经阻滞成功率，阿片类（舒芬太尼、瑞芬太尼）药用量，辅助镇痛情况差异无统计学意义。术后6、12、24 h 两组患者静息时VAS评分差异无统计学意义。术后6、12、24 h MG组 timed-up-and-go测试时间明显长于DG组（P<0.05）。两组患者均未出现穿刺部位血肿、周围神经损伤、局部麻醉药中毒、穿刺部位感染等不良反应。
结论 与收肌管处阻滞比较，超声引导下经大腿远端1/3处行连续隐神经阻滞可为膝关节镜手术提供相同的术后镇痛效果，并对运动能力影响更小，值得推广。 |
| 英文摘要: |
Objective To evaluate the analgesia effects and ambulation ability of ultrasound-guided continuous saphenous nerve blocks with different approaches for postoperative knee arthroscopy.
Methods Forty-eight patients, 42 males and 6 females, aged 25 - 33 year, weighing 65 - 81 kg, BMI 18.1 - 26.4 kg/m2, ASA physical status I or Ⅱ, scheduled for arthroscopic knee surgery underwent general anesthesia, were randomly divided into 2 groups （n = 24） using a random number table: adductor canal block group (group MG) and distal thigh block group (group DG). Two groups of patients received ultrasound guided saphenous nerve block before induction of anesthesia. In group MG, the catheter was placed in the space between the adductor tube; in group DG, the catheter was placed around the saphenous nerve for about 3 cm. Catheter palcement was confirmed by ultrasound in both groups, and the electronic self-controlled analgesia pump was connected and set up. A single dose of 0.5% ropivacaine +1% lidocaine 20 ml was administrated, and 0.2% ropivacaine was given by the analgesic pump. The success rate of nerve block, the consumption of opioids (sufentanil, remifentanil), the postoperative analgesic rescue rate, the resting VAS score at 6, 12, 24 h after operation， and the ambulation ability evaluated by timed-up-and-go were recorded. The occurrence of hematoma, peripheral nerve injury, local anesthetic toxicity and infection at puncture site 24 hours after operation were recorded.
Results The success rate of nerve block, the consumption of opioid (sufentanil, remifentanil), the incidence of adjuvant analgesic, VAS score at 6, 12, 24 h after operation were not significantly different between two groups. The timed-up-and-go test time at 6, 12, 24 h after operation in group MG was significantly longer than that in group DG (P<0.05). The adverse reactions including hematoma, peripheral nerve injury, local anesthetic toxicity and infection at puncture did not occured in patients of the two groups.
Conclusion Compared with the adductor canal block，continuous saphenous nerve block through 1/3 of the distal thigh can provide the same analgesia after knee arthroscopy and less influence on ambulation ability, which is worth popularizing. |
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