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| 布比卡因脂质体局部浸润联合收肌管阻滞对全膝关节置换术后运动功能的影响 |
| Effect of periarticular bupivacaine liposome injection combined with adductor canal block on motor function after total knee arthroplasty |
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| DOI：10.12089/jca.2026.08.006 |
| 中文关键词: 全膝关节置换术 布比卡因脂质体 收肌管阻滞 股神经阻滞 镇痛 |
| 英文关键词: Total knee arthroplasty Bupivacaine liposome Adductor canal block Femoral nerve block Analgesia |
| 基金项目:中国红十字基金会医学赋能公益专项基金2023年镇痛行动临床科研项目（CRCF-YXFN-202302172） |
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| 中文摘要: |
目的： 比较布比卡因脂质体局部浸润联合收肌管阻滞与股神经阻滞对全膝关节置换术（TKA）术后运动功能及镇痛效果的影响。
方法： 选择2024年1月至2025年9月于脊髓麻醉下行全膝关节置换术的中老年患者，年龄≥45岁，BMI≤40 kg/m2，ASA Ⅰ—Ⅲ级。将患者随机分为两组：布比卡因脂质体局部浸润联合收肌管阻滞组（LA组）和股神经阻滞组（FNB组）。LA组术中注射布比卡因脂质体266 mg/20 ml行膝关节周围局部浸润，FNB组注射生理盐水20 ml。术毕入麻醉恢复室（PACU），LA组于超声引导下行收肌管阻滞（ACB）；FNB组于超声引导下行FNB。主要指标为术后48 h起立行走试验（TUG）。次要指标包括术后24 h TUG，术后48 h内舒芬太尼用量、镇痛泵有效按压次数、镇痛泵总按压次数、补救镇痛率，术后6、24、48 h NRS疼痛评分、股四头肌肌力（QDS）及膝关节活动度（ROM）。不良反应包括恶心呕吐以及神经阻滞相关不良事件。
结果： 共纳入患者88例，每组44例。与FNB组比较，LA组术后24、48 h TUG明显缩短，术后48 h内舒芬太尼用量、镇痛泵有效按压次数和总按压次数明显减少，术后24、48 h NRS疼痛评分明显降低，QDS及ROM明显增大（P<0.05）。
结论： 相较于股神经阻滞，布比卡因脂质体局部浸润联合收肌管阻滞用于TKA患者，对术后运动功能的影响更小，镇痛效果更好。 |
| 英文摘要: |
Objective: To compare the effect of periarticular bupivacaine liposome injection combined with adductor canal block on motor function following total knee arthroplasty (TKA), as well as their impact on postoperative pain.
Methods: Patients scheduled to undergo TKA with spinal anesthesia from January 2024 to September 2025, aged ≥ 45 years, BMI ≤ 40 kg/m2, ASA physical status Ⅰ-Ⅲ, were randomly allocated into two groups: the local infiltrative analgesia combined adductor canal block group (group LA) and the femoral nerve block group (group FNB). Patients in group LA received periarticular injection of bupivacaine liposome 266 mg/20 ml around the knee during the surgery, patients in group FNB received normal saline 20 ml injection. After completion of surgery, patients were shifted to the post-anaesthesia care unit (PACU) where ultrasound-guided adductor canal block and femoral nerve block were performed. The primary outcome was the timed-up-and-go test (TUG) at 48 hours postoperatively. Secondary outcomes included TUG at 24 hours postoperatively, sufentanil dosage, the number of effective presses and the total number of presses of the analgesic pump within 48 hours postoperatively, incidence of remedial analgesia, NRS pain score, quadriceps strength (QDS), and range of motion (ROM) at 6, 24, and 48 hours postoperatively. Adverse reactions included postoperative nausea and vomiting and nerve block-related complications.
Results: Eighty-eight patients were enrolled in this study, 44 patients in each group. Compared with group FNB, the TUG shorterned significantly in group LA at 24 and 48 hours postoperatively, the sufentanil dosage and the number of effective presses and the total number of presses of the analgesic pump within 48 hours postoperatively in group LA were significantly lower, the NRS scores were significantly reduced, and the QDS and ROM were significantly higher in the LA group at 24 and 48 hours postoperatively (P < 0.05).
Conclusion: Compared with the femoral nerve block, periarticular bupivacaine liposome injection combined with adductor canal block appears to be superior for motor function in patients undergoing TKA, which minimizes effects on pain control. |
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