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中华关节外科杂志(电子版) ›› 2018, Vol. 12 ›› Issue (02) : 192 -196. doi: 10.3877/cma.j.issn.1674-134X.2018.02.009

所属专题: 文献

临床论著

收肌管阻滞技术在初次全膝置换术后早期镇痛中的应用研究
刘睿轩1, 刘宁1, 姜脉涛2, 张涛1, 陈维鑫1, 王文波1,()   
  1. 1. 150001 哈尔滨医科大学附属第一医院骨科
    2. 150001 哈尔滨医科大学附属第一医院腹部超声科
  • 收稿日期:2017-07-19 出版日期:2018-04-01
  • 通信作者: 王文波

Adductor canal blockade for early post-operative pain analgesia after primary total knee arthroplasty

Ruixuan Liu1, Ning Liu1, Maitao Jiang2, Tao Zhang1, Weixin Chen1, Wenbo Wang1,()   

  1. 1. Department of Orthopaedic, First Affiliated Hospital of Harbin Medical University, Harbin 150001, China
    2. Department of Ultrasound, First Affiliated Hospital of Harbin Medical University, Harbin 150001, China
  • Received:2017-07-19 Published:2018-04-01
  • Corresponding author: Wenbo Wang
  • About author:
    Corresponding author: Wang Wenbo, Email:
引用本文:

刘睿轩, 刘宁, 姜脉涛, 张涛, 陈维鑫, 王文波. 收肌管阻滞技术在初次全膝置换术后早期镇痛中的应用研究[J/OL]. 中华关节外科杂志(电子版), 2018, 12(02): 192-196.

Ruixuan Liu, Ning Liu, Maitao Jiang, Tao Zhang, Weixin Chen, Wenbo Wang. Adductor canal blockade for early post-operative pain analgesia after primary total knee arthroplasty[J/OL]. Chinese Journal of Joint Surgery(Electronic Edition), 2018, 12(02): 192-196.

目的

探讨收肌管阻滞术在全膝关节置换术术后疼痛管理及早期康复中的作用。

方法

前瞻性选取于哈尔滨医科大学附属第一医院骨科行初次行单侧全膝关节置换术(TKA)的患者40例,随机分为收肌管阻滞联合帕瑞昔布镇痛组20例及单纯帕瑞昔布镇痛组20例。纳入初次单侧TKA患者,排除严重感染和精神疾病等患者。收肌管阻滞置管术后立即执行。两组患者围手术期观察术后不同时间点的静息与活动状态下视觉模拟评分、股四头肌肌力、膝关节活动范围、住院天数及有无并发症发生。所得数据通过独立样本t检验、非参数Wilcoxon秩和检验以及卡方检验进行分析。

结果

与单纯应用帕瑞昔布相比,联合应用收肌管阻滞技术能够有效地降低患者术后早期VAS评分(术后6 h~72 h活动VAS:Z=-3.124、-2.157、-2.044、-2.467、-2.471,P <0.05;术后6 h~24 h静息VAS:Z=-2.310、-2.409、-2.208,P<0.05)。在膝关节活动度与术后住院时间上两组差异无统计学意义(P>0.05)。且收肌管阻滞组患者体现出更好的康复依从性,未出现因操作引起的并发症。

结论

全膝关节置换术术后辅助收肌管阻滞术能够有效地缓解患者术后疼痛,有助于患者早期开展功能锻炼与快速康复。

Objective

To evaluate the efficacy of adductor canal block(ACB) on pain management and early rehabilitation after total knee arthroplasty (TKA).

Methods

A total of 40 patients undergoing primary unilateral TKA in the first affilicated hospital of Harbin Medical University were randomly divided into two groups: ACB combined with parecoxib group (test group) and only parecoxib group (control group). Primary TKA patients were included, and the patients with severe infection or mental diseases were excluded. Adductor canal block was immediately performed. Perioperative data was calculated for statistical analysis.The data were analyzed with independent-samples t test, non-parameters Wilcoxon symbols test and chi-square test.

Results

Comparing the test group with the control group, significant differences were found in rest pain, activity pain in early stage postoperatively (postoperative 6 h~72 h active VAS: Z= -3.124, -2.157, -2.044, -2.467, -2.471, all P < 0.05; postoperative 6 h~24 h rest VAS: Z=-2.310, -2.409, -2.208, P<0.05). No difference was found in knee function and length of hospital stay between two groups(P>0.05). The patients in the test group showed better compliance of rehabilitation. Further more, no ACB complication was found.

Conclusion

ACB can effectively alleviate postoperative pain in TKA patients, and it could be helpful for fast functional recovery.

图1 收肌管阻滞技术示意图。A 超声定位;B超声图像,示位于股动脉外侧、缝匠肌深面的收肌管扩张区域;C患者术后佩戴自控镇痛泵活动
表1 患者术前一般临床资料
表2 实验组和对照组术后不同时点VAS评分[M(P25P75)]
表3 实验组和对照组术后不同时点膝关节活动度比较[°,M(P25P75)]
[1]
Wang D, Xu J, Zeng W, et al. Closed suction drainage is not associated with faster recovery after total knee arthroplasty: a prospective randomized controlled study of 80 patients[J]. Orthop Surg, 2016, 8(2):226-233.
[2]
Grosu I, Lavand’homme P, Thienpont E. Pain after knee arthroplasty: an unresolved issue[J]. Knee Surg Sports Traumatol Arthrosc, 2014, 22(8), 1744-1758.
[3]
徐掭发,詹科,胡俊勇,等.氨甲环酸在首次人工全膝关节置换术围手术期减少出血的研究[J/CD].中华关节外科杂志(电子版),2017,11(1):35-40.
[4]
Lovald ST, Ong KL, Lau EC, et al. Readmission and complications for catheter and injection femoral nerve block administration after total knee arthroplasty in the Medicare population[J]. J Arthroplasty, 2015, 30(12):2076-2081.
[5]
Chokhavatia S, John ES, Bridgeman MB, et al. Constipation in elderly patients with noncancer pain: focus on opioid-induced constipation[J]. Drugs Aging, 2016, 33(8):557-574.
[6]
Abdallah FW, Chan VW, Gandhi RA, et al. The analgesic effects of proximal, distal, or no sciatic nerve block on posterior knee pain after total knee arthroplasty a double-blind placebo-controlled randomized trial[J]. Anesthesiology, 2014, 121(6):1302-1310.
[7]
Essving P, Axelsson K, Kjellberg J, et al. Reduced hospital stay, morphine consumption, and pain intensity with local infiltration analgesia after unicompartmental knee arthroplasty[J]. Acta Orthop, 2009, 80(2):213-219.
[8]
Hebl JR, Kopp SL, Ali MH, et al. A comprehensive anesthesia protocol that emphasizes peripheral nerve blockade for total knee and total hip arthroplasty[J]. J Bone Joint Surg Am, 2005, 87(2), 63-70.
[9]
Pelt CE, Anderson AW, Anderson MB, et al. Postoperative falls after total knee arthroplasty in patients with a femoral nerve catheter: can we reduce the incidence? [J]. J Arthroplasty, 2014, 29(6), 1154-1157.
[10]
Shah NA, Jain NP, Panchal KA. Adductor canal blockade following total knee Arthroplasty-Continuous or single shot technique? Role in postoperative analgesia, ambulation ability and early functional recovery: a randomized controlled trial[J]. J Arthroplasty, 2015, 30(8):1476-1481.
[11]
Kwofie MK, Shastri UD, Gadsden JC, et al. The effects of ultrasound-guided adductor canal block versus femoral nerve block on quadriceps strength and fall risk: a blinded, randomized trial of volunteers[J]. Reg Anesth Pain Med, 2013, 38(4):321-325.
[12]
Ilfeld BM, Duke KB, Donohue MC. The association between lower extremity continuous peripheral nerve blocks and patient falls after knee and hip arthroplasty[J]. Anesth Analg, 2010, 111(6):1552-1554.
[13]
Horlocker TT, Wedel DJ, Benzon H, et al. Regional anesthesia in the anticoagulated patient: defining the risks (the second ASRA Consensus Conference on Neuraxial Anesthesia and Anticoagulation)[J]. Reg Anesth Pain Med, 2003, 28(3):172-197.
[14]
Akkaya T, Ersan O, Ozkan D, et al. Saphenous nerve block is an effective regional technique for post-menisectomy pain[J]. Knee Surg Sports Traumatol Arthrosc, 2008, 16(9):855-858.
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