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中华老年骨科与康复电子杂志[ISSN:1674-3911/CN:11-9292/R]

卷:

期数:

2022年06期

页码:

367-373

栏目:

麻醉医学

出版日期:

2022-12-05

文章信息/Info

Title:

The analgesic effect of different position adductor canal block guided by ultrasound for senile patients after total knee arthroplasty

作者:

周立杰; 王现雷; 吴振宇; 刘文超; 于洋

066000 秦皇岛市第一医院麻醉科

Author(s):

Zhou Lijie;  Wang Xianlei;  Wu Zhenyu;  Liu Wenchao;  Yu Yang.

Department of Anesthesiology, First Hospital of Qinhuangdao, Qinhuangdao 066099, China

关键词:

超声引导;  收肌管阻滞;  膝关节置换术;  术后镇痛

Keywords:

Ultrasonic guidance;  Adductor canal block;  Total knee arthroplasty;  Postoperative analgesia

DOI:

10.3877/cma.j.issn.2096-0263.2022.06.008

文献标志码:

A

摘要:

目的 探讨超声引导下不同位置收肌管阻滞用于老年患者在全身麻醉下接受单侧全膝关节置换术后的镇痛效果。方法 前瞻性收集2019年9月10日至2021年6月30日于秦皇岛市第一医院接受单侧膝关节置换术的老年患者64例，男性34例，女性30例，年龄65～83岁，按照随机数字表法分为两组（n=32），对照组采用超声引导下近端收肌管阻滞，观察组为远端收肌管阻滞。记录两组手术情况包括手术时间，神经阻滞操作时间，术中出血量和术后48 h内引流量，比较两组患者术后疼痛程度、镇痛泵按压和镇痛补救次数、股四头肌肌力以及膝关节活动情况。结果 64例患者均获得随访，随访时间10～12个月。两组患者在手术时间、神经阻滞操作时间、术中出血量、术后引流量、术后镇痛药物补救方面差异无统计学意义。两组患者VAS评分和患肢活动情况进行重复测量方差分析，结果显示静息状态下VAS评分不同时间点之间差异有统计学意义（F=29.342，P=0.000）。活动时VAS 评分两组间差异有统计学意义（F=12.295，P=0.001），不同时间点之间差异有统计学意义（F=3.373，P=0.010）。术后股四头肌肌力两组患者之间差异有统计学意义（F=6.918，P=0.011），两组术后膝关节活动度有差异（F=7.263，P=0.009），不同时间点差异有统计学意义（F=25.238，P=0.000）。结论 远端收肌管阻滞为老年全麻下膝关节置换术后提供较为理想的镇痛效果，对股四头肌肌力影响较小，有利于早期运动功能恢复。

Abstract:

Objective To investigate the analgesic effect of ultrasound guided adductor tube block in different positions in elderly patients undergoing unilateral total knee arthroplasty under general anesthesia.Methods 64 elderly patients (34 males, 30 females, 65-83 years old) who underwent unilateral knee arthroplasty in the First Hospital of Qinhuangdao from September 10, 2019 to June 30, 2021 were prospectively collected and divided into two groups according to the random number table method (n=32).The control group received ultrasound-guided proximal adductor tube block. Observation group was distal adductor tube block.The operation time, nerve block operation time, intraoperative blood loss and drainage volume within 48 hours after operation were recorded. The degree of postoperative pain, times of analgesic pump compression and analgesic relief, quadriceps muscle strength and knee joint activity were recorded. Results All 64 patients were followed up for 10-12 months. There were no significant differences in operation time, nerve block operation time, intraoperative blood loss, postoperative drainage volume, and postoperative analgesic drug recovery between the two groups. The VAS score and limb activity of the two groups at different time points after operation were analyzed by repeated measures ANOVA. The results showed that there were statistically significant differences in VAS score at different time points in the resting state (F=29.342, P=0.000). There was a significant difference in VSA score between the two groups at the time of activity (F=12.295, P=0.001), and there was a significant difference between the two groups at different time (F=3.373, P=0.010). Postoperative quadriceps muscle strength was significantly different between the two groups (F=6.918, P=0.011), knee joint range of motion was significantly different between the two groups (F=7.263, P=0.009), and the difference was statistically significant at different time points (F=25.238, P=0.001). Conclusion Distal adductor tube block can provide ideal analgesic effect for elderly patients after knee arthroplasty under general anesthesia. It has little effect on quadriceps muscle strength and is beneficial to early recovery of motor function.

备注/Memo

备注/Memo:

基金项目：秦皇岛科技局项目（202101A045）

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更新日期/Last Update: 2023-01-04