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| 远端和近端入路腘动脉与膝关节囊后间隙阻滞联合收肌管阻滞对老年患者全膝关节置换术后镇痛的影响 |
| Analgesia of infiltration between the politeal artery and capsule of the posterior knee through distal and proximal approaches for elderly patients undergoing total knee arthroplasty |
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| DOI：10.12089/jca.2022.02.010 |
| 中文关键词: 神经阻滞 腘动脉与膝关节囊后间隙 收肌管 关节成形术 老年 |
| 英文关键词: Nerve block Interspace between popliteal artery and capsule of the posterior knee Adductor canal Arthroplasty Aged |
| 基金项目:河北省医学科学研究课题计划项目（20191236）；河北省研究生创新资助项目（CXZZSS2021143） |
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| 中文摘要: |
目的 比较远端和近端入路腘动脉与膝关节囊后间隙阻滞（IPACK）对老年患者全膝关节置换术后的镇痛效果和对运动功能的影响。
方法 选择2020年4月至2021年4月行全膝关节置换术老年患者60例，男31例，女29例，年龄65～80岁，BMI 20～30 kg/m2，ASA Ⅱ或Ⅲ级。采用随机数字表法将患者分为两组：远端IPACK组（D组）和近端IPACK组（P组），每组30例。麻醉诱导前D组采用含肾上腺素0.1 mg的0.25%罗哌卡因20 ml行远端IPACK，P组采用含肾上腺素0.1 mg的0.25%罗哌卡因20 ml行近端IPACK。D组和P组均于IPACK完成后行收肌管阻滞，并留置神经周围导管。当术后VAS疼痛评分>4分，且患者按压镇痛泵后30 min未缓解时，皮下注射羟考酮5 mg进行镇痛补救。记录IPACK操作时间、腓总神经运动阻滞例数、补救镇痛例数、镇痛泵有效按压次数、术前及术后1、2、3 d患者主动屈膝最大角度和步行距离，记录局麻药物中毒、穿刺部位感染、血肿、院内跌倒等不良事件发生情况。
结果 与P组比较，D组IPACK操作时间明显缩短（P<0.05），腓总神经运动阻滞率、补救镇痛率明显降低（P<0.05），镇痛泵有效按压次数明显减少（P<0.05），术后1、2 d步行距离明显延长（P<0.05）。两组术前、术后1、2、3 d患者主动屈膝最大角度及术后3 d步行距离差异无统计学意义。
结论 远端IPACK用于老年患者全膝关节置换术，操作简便，镇痛效果明显，对运动功能影响小，效果优于近端IPACK。 |
| 英文摘要: |
Objective To compare the analgesic and motor effect of infiltration between the politeal artery and capsule of the posterior knee (IPACK) through distal and proximal approaches for elderly patients undergoing total knee arthroplasty (TKA).
Methods Sixty elderly patients scheduled for TKA from April 2020 to April 2021, 31 males and 29 females, aged 65-80 years, BMI 20-30 kg/m2, ASA physical status Ⅱ or Ⅲ, were randomly divided into two groups using random number table method: distal IPACK group (group D) and proximal IPACK group (group P), 30 patients in each group. Distal IPACK was performed with 20 ml of 0.25% ropivacaine containing epinephrine 0.1 mg in group D and proximal IPACK was performed with 20 ml of 0.25% ropivacaine containing epinephrine 0.1 mg in group P before anethesia induction. Adductor canal block was performed and peripheral nerve catheter was inserted after IPACK in groups D and P. When VAS score > 4 and pain was not relived after 30 minutes pressing by patients, oxycodone hydrochloride 5 mg was subcutaneously injected as rescue analgesic. The operation time of IPACK, motor block rate of common peroneal nerve, rate of analgesic remedy, effective compression times of analgesic pump, the number of ambulatory steps and the maximum range of knee motion on preoperative and 1, 2, 3 days after TKA were recorded. The occurrence of adverse events (local anesthesia drug poisoning, puncture site infection, hematoma and hospital fall) were recorded.
Results Compare with group P, the operation time of IPACK, motor block rate of common peroneal nerve, rate of analgesic remedy, and effective compression times of analgesic pump were decreased significantly in group D (P < 0.05), the number of ambulatory steps on 1 day and 2 days after TKA were increased significantly in group D (P < 0.05). There were no significantly differences in the maximum range of knee motion on preoperative and 1, 2, 3 days and the number of ambulatory steps 3 days after TKA between groups D and P.
Conclusion Based on the advantages of simple operation, exact analgesia and less impact on motor function, distal IPACK is superior to proximal IPACK for elderly patients undergoing total knee arthroplasty． |
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