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| 复方倍他米松佐剂对坐骨神经联合股神经阻滞下膝关节单髁置换术后爆发痛的影响 |
| The effects of sciatic and femoral nerve block combined with compound betamethasone on rebound pain after unicondylar knee arthroplasty |
| 投稿时间：2023-07-19 修订日期：2024-03-19 |
| DOI： |
| 中文关键词: 爆发痛，神经阻滞，复方倍他米松，地塞米松，膝关节单髁置换术 |
| 英文关键词: rebound pain,nerve block,betamethason copound injection, dexamethasone, unicondylar knee arthroplasty |
| 基金项目:2022年度河北省“三三三人才工程”资助项目(C20221095)。 |
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| 中文摘要: |
| 目的 探讨复方倍他米松佐剂对坐骨神经联合股神经阻滞下膝关节单髁置换术后爆发痛的影响。方法 选择单侧膝关节单髁置换术患者108例，男34例，女74例，年龄55~75岁，BMI 18~35 kg/m2，ASA I—III级，根据随机数字表法将患者分为三组：无佐剂组（C组）、地塞米松佐剂组（D组）和复方倍他米松佐剂组（B组），每组36例。三组患者先行坐骨神经阻滞，注入0.4%罗哌卡因15 ml，再行股神经阻滞，C组注入0.4%罗哌卡因15 ml，D组注入0.4%罗哌卡因15 ml（含地塞米松5 mg），B组注入0.4%罗哌卡因15 ml（含复方倍他米松4 mg）。记录术后爆发痛发生情况、爆发痛评分、术后72 h内静息和活动时NRS评分、术后自控镇痛泵按压情况、术后镇痛药物用量。记录术后0~24 h、24~48 h、48~72 h下地活动距离、睡眠质量评分以及不良事件发生情况。结果 与C组比较，B组术后爆发痛发生率明显降低(P<0.05)，术后8、16、24 h静息时NRS评分明显降低(P<0.05)，术后24 h活动NRS评分明显降低(P<0.05)，术后72 h内术后自控镇痛泵有效按压次数、阿片类药物用量明显降低(P<0.05)，术后第1晚睡眠质量评分降低(P<0.05)；D组术后8、16 h静息时NRS疼痛评分明显降低(P<0.05)。与D组比较，B组术后爆发痛发生率明显降低(P<0.05)，爆发痛评分明显降低(P<0.05)，术后24 h静息和活动时NRS疼痛评分明显降低(P<0.05)，术后72 h内术后自控镇痛泵有效按压次数、阿片类药物用量明显降低(P<0.05)，术后第1晚睡眠质量评分明显降低(P<0.05)。三组患者不良事件发生率差异无统计学意义。结论 复方倍他米松佐剂可降低坐骨神经联合股神经阻滞下膝关节单髁置换术后爆发痛发生率，提供完善镇痛效果，减少术后阿片类药物用量，提高患者术后第1晚睡眠质量。 |
| 英文摘要: |
| 【Abstract】Objective To explore the rebound pain after unicondylar knee replacement by sciatic and femoral nerve block combined with compound betamethasone. Methods A total of 108 patients underwent unicondylar knee arthroplasty, 34 males and 74 females, aged 55-75 years, BMI 18-35 kg/m2, ASA physical status I - III, and were divided into three groups according to random number table method: no adjuvant group (group C), dexamethasone adjuvant group (group D) and compound betamethasone adjuvant group (group B), 36 patients in each group. The patients in the three groups received sciatic nerve block first and 0.4% ropivacaine 15 ml, then femoral nerve block, 0.4% ropivacaine 15 ml in group C, 0.4% ropivacaine 15 ml in group D (containing dexamethasone 5 mg), and 0.4% ropivacaine 15 ml in group B (containing compound becamethasone 4 mg). The occurrence of rebound pain, NRS at rest and activity within 72 h after surgery, self-controlled postoperative analgesic pump compression, postoperative analgesic drug dosage, movement distance, sleep quality score and adverse events were recorded after operation. Results Compared with group C, group B had a lower incidence of rebound pain (P<0.05), lower resting NRS at 8, 16 and 24 h postoperatively (P<0.05), lower active NRS at 24 h postoperatively (P<0.05), the number of effective compressions of self-controlled analgesia pump and the dosage of opioid were significantly decreased (P<0.05), and lower sleep quality score on the 1st night after operation (P<0.05); resting NRS was lower in group D at 8 and 16 h postoperatively (P<0.05). Compared with group D, group B had a lower incidence of rebound pain (P<0.05), lower rebound pain score (P<0.05), lower resting and activity NRS at 24 h postoperatively (P<0.05), the number of effective compressions of self-controlled analgesia pump and the dosage of opioid were significantly decreased (P<0.05), and the score of sleep quality on the 1st night after surgery was significantly decreased (P<0.05). No significant difference in the incidence of adverse events among the three groups. Conclusion The sciatic and femoral nerve block combined with compound betamethasone in unicondylar knee arthroplasty can reduce the incidence of rebound pain, provide perfect analgesia, reduce the dosage of postoperative opioids, and improve the sleep quality on the first night after surgery. |
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