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| 右美托咪定或羟考酮复合罗哌卡因连续股神经阻滞用于全膝关节置换术后镇痛的效果 |
| Effect of dexmedetomidine or oxycodone combined with ropivacaine for continuous femoral nerve block after total knee arthroplasty |
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| DOI：10.12089/jca.2019.08.001 |
| 中文关键词: 连续股神经阻滞 全膝关节置换术 右美托咪定 羟考酮 |
| 英文关键词: Continuous femoral nerve block Total knee arthroplastic surgery Dexmedetomidine Oxycodone |
| 基金项目: |
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| 中文摘要: |
目的 探讨右美托咪定或羟考酮复合罗哌卡因连续股神经阻滞用于全膝关节置换术后镇痛的效果。
方法 接受单侧全膝关节置换手术患者90例，男19例，女71例，年龄60～75岁，体重45～80 kg，ASA Ⅰ—Ⅲ级。所有患者均采用全身麻醉，术后行连续股神经阻滞。将患者随机分为三组：罗哌卡因复合舒芬太尼12 μg/ml组（RS组）、罗哌卡因复合右美托咪定2 μg/ml组（RD组）和罗哌卡因复合羟考酮0.1 mg/ml组（RO组）。记录术后第1、2、3天及出院当天静息时、运动时VAS评分和患肢股四头肌肌力;记录术后第1、2、3天及出院当天患者运动能力和术后恶心呕吐、心动过缓、下肢麻木、皮肤瘙痒等不良反应及镇痛失败发生情况。
结果 术后第1、2天和出院当天三组静息VAS评分差异无统计学意义。术后第3天RS组和RO组静息VAS评分明显高于RD组（P<0.05）。术后第1天RS组和RO组运动VAS评分明显低于RD组（P<0.05），其余时点三组运动VAS评分差异无统计学意义。术后第3天和出院当天三组股四头肌肌力差异无统计学意义。出院当天三组股四头肌肌力均明显高于术后第1、2天（P<0.05）。术后第3天和出院当天三组下肢活动能力差异无统计学意义。RD组心动过缓发生率明显高于R组和RO组（P<0.05），其他不良反应三组差异无统计学意义。
结论 罗哌卡因复合右美托咪定连续股神经阻滞术后镇痛，静息痛镇痛效果较好，且持续时间较长。罗哌卡因复合羟考酮连续股神经阻滞术后镇痛与罗哌卡因复合舒芬太尼镇痛效果相当。两种药物复和罗哌卡因连续股神经阻滞均能够有效维持患者的股四头肌肌力和正常活动能力，不良反应发生率低。 |
| 英文摘要: |
Objective To investigate the clinical effect of dexmedetomidine and oxycodone combined with ropivacaine continuous femoral nerve block (CFMB) for analgesia after total knee arthroplasty (TKA) surgery.
Methods Ninety patients with unilateral TKA, aged 60-75 years, weighing 45-80 kg, ASA physical status Ⅰ-Ⅲ, were enrolled in this study. All patients received general anesthesia and continuous femoral nerve block for postoperative analgesia. The patients were randomly divided into three groups: simple ropivacaine group (group R), ropivacaine combined with dexmedetomidine 2 μg/ml group (group RD) and ropivacaine combined with oxycodone 0.1 mg/ml group (group RO).
Results There were no significant differences in the postoperative resting VAS scores between the three groups 1 day and 2 days after surgery. Three days after surgery, the resting VAS scores of group RS and group RO were significantly higher than those in group RD (P < 0.05). The VAS scores of group RS and group RO were significantly lower than those of group RD 1 day postoperatively (P < 0.05). There was no significant difference in VAS scores between the three groups. There was no significant difference in the strength of the quadriceps muscles between the three groups after surgery and the day of discharge. The muscle strength of the quadriceps muscles in the three groups was higher than those on the first day and the second day after surgery (P < 0.05). There was no significant difference in lower limb mobility between the last three days and discharge day. The incidence of bradycardia in group RD was higher than those in group R and group RO (P < 0.05); there was no significant difference between the other three adverse reactions.
Conclusion Ropivacaine combined with dexmedetomidine CFNB for postoperative analgesia, analgesia of rest pain is better, and lasts longer; ropivacaine combined with oxycodone CFCB postoperative analgesia combined with ropivacaine Sufentanil is comparable to its analgesic effect. Both drugs combined with ropivacaine CFCB can effectively maintain the quadriceps muscle strength and normal mobility of patients, and the incidence of adverse reactions is low. It can be widely used in clinic. |
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