老年膝关节置换术后超声引导下的 两种神经阻滞镇痛效果比较

Effect comparison between ultrasound-guided fascia iliaca compartment nerve block and adductor canal block in analgesia for elderly patients after knee joint surgery

摘要:

目的 比较超声引导下髂筋膜间隙神经阻滞（FICNB）与收肌管阻滞（ACB）用于老年膝关节置 换术（EKR）后的镇痛效果。方法 按随机数字表法将拟行全身麻醉下膝关节置换术的120 例老年患者分为 A 组和B 组，每组各60 例。两组均于术前30 min 给予神经阻滞干预，A 组于超声引导下行FICNB，B 组则行 ACB。比较两组不同时间、不同区域感觉阻滞有效率、术后不同时间的静息和运动状态下视觉模拟评分（VAS） 及股四头肌肌力和不良反应情况。结果 两组股神经阻滞后有效率比较，差异无统计学意义（P >0.05）；A 组 股外侧皮神经、闭孔神经阻滞有效率均高于B 组（P <0.05）；A 组术后静息和运动状态下的VAS 评分均低于 B 组（P <0.05）；A 组术后24 h 股四头肌肌力小于B 组（P <0.05）；两组术后48 h 股四头肌肌力、药物不良 反应发生率比较，差异无统计学意义（P >0.05）。结论 超声引导下髂FICNB 相比ACB 用于EKR 后镇痛效 果更佳，前者术后24 h 对股四头肌肌力影响相对大，但术后48 h 影响减小，建议根据情况选择合适神经阻滞方式。

Abstract:

Objective To compare the analgesic effect of ultrasound-guided fascia iliaca compartment nerve block (FICNB) and adductor canal block(ACB) in analgesia for elderly patients after knee replacement. Methods A total of 120 elderly patients undergoing knee replacement under general anesthesia were randomly divided into group A and group B with 60 cases in each group. Both group were given nerve block intervention 30 min before surgery. Group A were given ultrasound-guided FICNB while group B were given ACB. The effective rates of sensory block in different regions, resting and active visual analogue scores (VAS), muscle strength of quadriceps femoris and adverse reactions were compared between the two groups. Results The effective rates of lateral femoral cutaneous nerve and obturator nerve sensory block in group A 10 min, 20 min and 30 min after nerve block were significantly higher than those in group B (P < 0.05). The resting and active VAS scores of group A 2 h, 6 h, 12 h, 24 h and 48 h after surgery were significantly lower than those of group B (P < 0.05). The muscle strength of quadriceps femoris of group A 24 h after surgery was significantly smaller than that of group B (P < 0.05). There were no significant differences between the two groups in the muscle strength of quadriceps femoris and the incidence of adverse drug reactions 48 h after operation (P > 0.05). Conclusion Compared with adductor canal block, the analgesic effect of ultrasound-guided FICNB is more significant in the elderly after knee replacement. Though the effect of the later on muscle strength of quadriceps femoris is relatively greater 24 h after surgery, the effect decreases 48 h after surgery, it is recommended to choose the appropriate nerve block depending on the situation.