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中华关节外科杂志(电子版)

中华关节外科杂志(电子版) ›› 2019, Vol. 13 ›› Issue (06) : 679 -683. doi: 10.3877/cma.j.issn.1674-134X.2019.06.005

所属专题： 文献；

临床论著

神经阻滞在膝关节置换术后镇痛的应用研究
王波1, 石川1, 井文森1, 李政1, 胡守业1, 许珂1, 许鹏1,†()   
  1. 1. 710000　西安交通大学附属红会医院
  • 收稿日期:2019-04-30 出版日期:2019-12-01
  • 通信作者: 许鹏
  • 基金资助:
    国家自然科学基金(81601877)

Clinical study of application of nerve block in early analgesia after total knee replacement

Bo Wang1, Chuan Shi1, Wensen Jing1, Zheng Li1, Shouye Hu1, Ke Xu1, Peng Xu1,†()   

  1. 1. Honghui Hospital, Xi’an Jiaotong University, Xi’an 710000, China
  • Received:2019-04-30 Published:2019-12-01
  • Corresponding author: Peng Xu
  • About author:
    Corresponding author: Xu Peng, Email:
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引用本文：

王波, 石川, 井文森, 李政, 胡守业, 许珂, 许鹏. 神经阻滞在膝关节置换术后镇痛的应用研究[J/OL]. 中华关节外科杂志(电子版), 2019, 13(06): 679-683.

Bo Wang, Chuan Shi, Wensen Jing, Zheng Li, Shouye Hu, Ke Xu, Peng Xu. Clinical study of application of nerve block in early analgesia after total knee replacement[J/OL]. Chinese Journal of Joint Surgery(Electronic Edition), 2019, 13(06): 679-683.

目的

全膝关节置换术(TKA)是治疗终末期膝关节骨关节炎和类风湿性关节炎的最有效方法，而术后疼痛管理效果是直接影响患者功能康复的重要因素之一。因此，本研究试图探索股神经阻滞(FNB)联合膝关节周围局部浸润阻滞(PAI)在TKA术后早期的镇痛效果，并讨论分析其临床应用价值及前景。

方法

根据纳入标准及排除标准，回顾性纳入2018年10月8日至2019年2月8日因骨关节炎和类风湿性关节炎在关节病院骨坏死与关节重建病区行TKA的126例患者，接受PNB＋PAI者为实验组，接受FNB＋内收肌管阻滞(ACB)者为对照组，每组63例，所有患者的手术均由同一术者完成。分别采用t检验比较两组患者术前、术后6、12、24、48、72 h膝关节视觉模拟疼痛评分(VAS)、阿片类药物用量及膝关节活动度(ROM)，采用卡方检验比较两组恶心呕吐发生率。

结果

两组患者术前人口学特征及术前VSA评分差异无统计学意义(P>0.05)，所有患者均随访72 h。术后6、12、24 h实验组VAS评分低于对照组(t＝3.232、2.946、3.146，P<0.05)，术后48、72 h两组VAS评分差异无统计学意义(t ＝0.527、1.108、P>0.05)，术后24 h实验组膝关节活动度优于对照组(t＝3.082，P<0.05)，术后48、72 h两组患者膝关节活动度(t＝0.543、0.902，P>0.05)、阿片类药物用量(t＝0.857，P>0.05)、恶心呕吐发生率(χ2＝52.29，P>0.05)在两组差异无统计学意义，两组患者均未出现股四头肌无力、局部血肿等不良并发症。

结论

FNB＋PAI在TKA术后早期疼痛管理中效果确切，同FNB＋ACB相比，在术后24 h内的镇痛作用及膝关节活动度更优，因此，该方法可以作为FNB＋ACB的替代方法，并可以在TKA中推广应用。

关键词: 关节成形术，置换，膝, 神经阻滞, 镇痛
Objective

To observe the analgesia effects of femoral nerve block(FNB)combined with periarticular injection(PAI) in early postoperation after total knee replacement (TKA), and analyze its clinical application value and prospect.

Methods

A total of 126 patients(126 knees) were retrospectively included in this study according to inclusion criteria and exclusion criteria, who accepted TKA from October, 2018 to February, 2019.The patients were divided into the experimental group who accepted FNB+ PAI(n=63) and the control group who accepted FNB+ ACB(n=63). All the surgeries were completed by one experienced doctor. The results of visual analogue score(VAS), opioid consumption(using t test), the incidence of nausea and vomiting, and the knee range of motion(ROM) were compared between the two groups before and at six, 12, 24, 48 and 72 h after surgery(using chi-square test).

Results

There was no statistical difference between the two groups on preoperative demographic characteristics and preoperative VSA score (P>0.05). VAS scores in the experimental group were lower than those in the control group at six, 12, 24 h after surgery(t=3.232, 2.946, 3.146, P<0.05), and had no statistical difference at 48, 72 h after surgery(t=0.527, 1.108, P>0.05). The knee ROM in experimental group was better than that in control group at 24 h after surgery(t=3.082, P<0.05), and had no difference at 48, 72 h after surgery(t=0.543, 0.902, P>0.05). The opioids consumption(t=0.857, P>0.05), the incidence of nausea and vomiting (χ2=52.29, P>0.05) were the same in both groups. None of the patients occurred quadriceps weakness, nor the local hematoma complications.

Conclusion

When compared with FNB+ ACB, FNB+ PAI is an effective method in early postoperative analgesia therapy after TKA, with better pain and wide ROM at 24 h after surgery, which can be an alternative method for FNB+ ACB.

Key words: Arthroplasty, replacement, knee, Nerve block, Analgesia
表1 术前基本资料(±s)
组别 例数 年龄(岁) 膝内翻(°) 膝外翻(°) VAS休息(分) VAS活动(分) ROM(°)
实验组 63 66.8±7.1 5.8±3.6 4.4±2.7 1.5±0.6 5.8±2.0 92.6±18.5
对照组 63 65.7±8.4 5.6±4.1 4.8±2.2 1.7±0.5 5.4±2.5 94.3±16.4
t值 － 0.854 0.597 0.502 0.311 1.126 0.986
P值 － >0.05 >0.05 >0.05 >0.05 >0.05 >0.05
表2 两组术后不同时间点VAS评分[分，(±s)]
组别 例数 术后6 h 术后12 h 术后24 h 术后48 h 术后72 h
实验组 63 1.2±0.4 1.3±0.3 1.6±0.7 2.9±0.5 2.8±0.6
对照组 63 1.8±0.6 2.0±0.5 2.0±1.1 2.8±0.9 2.8±0.6
t值 ? 3.232 2.946 3.164 0.527 1.018
P值 ? <0.01 <0.05 <0.01 >0.05 >0.05
表3 两组术后不同时间点膝关节ROM [°，(±s)]
组别 术前 术后24 h 术后48 h 术后72 h
实验组 93±18 60±13 76±16 96±10
对照组 94±16 52±11 75±16 93±13
t值 0.986 3.082 0.543 0.902
P值 >0.05 <0.01 >0.05 >0.05
[1]
Kurtz S, Ong K, Lau E. Projections of primary and revision hip and knee arthroplasty in the United States from 2005 to 2030[J]. J Bone Joint Surg Am, 2007, 4 (4): 780-785.
[2]
Sardana V, Burzynski JM, Scuderi GR. Adductor canal block or local infiltrate analgesia for pain control after total knee arthroplasty? A systematic review and meta-analysis of randomized controlled trials[J]. J Arthroplasty, 2019, 34 (1): 183-189.
[3]
Terkawi AS, Mavridis D, Sessler DI, et al. Pain management modalities after total knee arthroplasty[J]. Anesthesiology, 2017, 126 (5): 923-937.
[4]
Saraev AV, Kornilov NN, Kulyaba TA. Efficiency of the multimodal approach to analgesia in total knee arthroplasty[J]. Khirurgiia, 2018, (6): 83-90.
[5]
Li DH, Tan Z, Kang PD, et al. Effects of multi-site infiltration analgesia on pain management and early rehabilitation compared with femoral nerve or adductor canal block for patients undergoing total knee arthroplasty: a prospective randomized controlled trial[J]. Int Orthop, 2017, 41(1): 75-83.
[6]
Seangleulur A, Vanasbodeekul P, Prapaitrakool S, et al. The efficacy of local infiltration analgesia in the early postoperative period after total knee arthroplasty: a systematic review and meta-analysis[J]. Eur J Anaesthesiol, 2016, 33(11): 816-831.
[7]
Zhang YY, Lu M, Chang C. Local anesthetic infusion pump for pain management following total knee arthroplasty: a meta-analysis[J]. BMC Musculoskelet Disord, 2017, 18(1): 32-43.
[8]
臧学慧，孙辉，高立华，等．股神经阻滞镇痛对全膝关节置换术后早期功能的影响[J/CD]．中华关节外科杂志(电子版)，2016，10(2):26-29.
[9]
Ma LP, Qi YM, Zhao DX. Comparison of local infiltration analgesia and sciatic nerve block for pain control after total knee arthroplasty: a systematic review and meta-analysis[J]. J Orthop Surg Res, 2017, 12(1): 85-97.
[10]
刘睿轩，刘宁，姜脉涛，等. 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/CD]. 中华关节外科杂志(电子版)，2018，12(2):192-196.
[11]
Albrecht E, Guyen O, Jacot-Guillarmod A, et al. The analgesic efficacy of local infiltration analgesia vs femoral nerve block after total knee arthroplasty: a systematic review and meta-analysis[J]. Br J Anaesth, 2016, 116(5): 597-609.
[12]
Li J, Deng XL, Jiang T. Combined femoral and sciatic nerve block versus femoral and local infiltration anesthesia for pain control after total knee arthroplasty: a meta-analysis of randomized controlled trials[J]. J Orthop Surg Res, 2016, 11(1): 158-172.
[13]
Macrinici GI, Murphy C, Christman L, et al. Prospective, double-blind, randomized study to evaluate Single-Injection adductor canal nerve block versus femoral nerve block: postoperative functional outcomes after total knee arthroplasty[J]. Reg Anesth Pain Med, 2016, 42(1): 10-16.
[14]
Ashraf A, Raut VV, Canty SJ, et al. Pain control after primary total knee replacement. A prospective randomised controlled trial of local infiltration versus single shot femoral nerve block[J]. Knee, 2013, 20(5): 324-327.
[15]
Tanikawa H, Harato K, Ogawa R, et al. Local infiltration of analgesia and sciatic nerve block provide similar pain relief after total knee arthroplasty[J]. J Orthop Surg Res, 2017, 12(1): 109-115.
[16]
Song M, Kim B, Ahn S, et al. Peri-articular injections of local anaesthesia can replace patient-controlled analgesia after total knee arthroplasty: a randomised controlled study[J]. Int Orthop 2016, 40(2): 295-299.
[17]
Gabriel RA, Ilfeld BM. Novel methodologies in regional anesthesia for knee arthroplasty[J]. Anesthesiol Clin, 2018, 36 (3): 387-401.
[18]
George NE, Gurk-Turner C, Etcheson JI, et al. The addition of diclofenac to a multimodal pain control regimen decreases postoperative pain and opioid consumption[J]. Surg Technol Int, 2017, 31: 346-351.
[19]
Gaffney CJ, Pelt CE, Gililland JM, et al. Perioperative pain management in hip and knee arthroplasty[J]. Orthop Clin North Am, 2017, 48(4): 407-419.
[20]
Zhou M, Ding H, Ke J. Adductor canal block in combination with posterior capsular infiltration on the pain control after TKA[J]. Ir J Med Sci, 2018, 187(2): 465-471.
[21]
De Jonge T, Gorgenyi S, Szabo G, et al. Local infiltration analgesia in total joint replacement[J]. Orv Hetil, 2017, 158 (9): 352-357.
[22]
Ross JA, Greenwood AC, Sasser IP. Periarticular injections in knee and hip arthroplasty: where and what to inject[J]. J Arthroplasty, 2017, 32(9, S): S77-S80.
[23]
Perret M, Fletcher P, Firth L, et al. Comparison of patient outcomes in periarticular and intraarticular local anaesthetic infiltration techniques in total knee arthroplasty[J]. J Orthop Surg Res, 2015, 10(1): 119-126.
[24]
Laoruengthana A, Rattanaprichavej P, Rasamimongkol S, et al. Anterior vs posterior periarticular multimodal drug injections: a randomized, controlled trial in simultaneous bilateral total knee arthroplasty[J]. J Arthroplasty, 2017, 32(7): 2100-2104.
[25]
Alijanipour P, Tan TL, Matthews CN, et al. Periarticular injection of liposomal bupivacaine offers no benefit over standard bupivacaine in total knee arthroplasty: a prospective, randomized, controlled trial[J]. J Arthroplasty, 2017, 32(2): 628-634.
[26]
Jain RK, Porat MD, Klingenstein GG, et al. The AAHKS clinical research award: liposomal bupivacaine and periarticular injection are not superior to single-shot intra-articular injection for pain control in total knee arthroplasty[J]. J Arthroplasty, 2016, 31 (9 Suppl): 22-25.
[27]
Kuang MJ, Du YR, Ma JX, et al. The efficacy of liposomal bupivacaine using periarticular injection in total knee arthroplasty: a systematic review and meta-analysis[J]. J Arthroplasty, 2017, 32(4): 1395-1402.
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