比较连续股神经阻滞(CFNB)与单次股神经阻滞(SFNB)联合关节腔周围注射(PAI)对全膝关节置换术(TKA)术后早期疼痛和肌力的影响。

回顾性分析2020年1月至2020年12月期间于北京大学第三医院骨科行TKA的患者资料。纳入由同一工作组完成手术及围术期管理且麻醉方式为椎管内麻醉的单侧初次TKA的患者，并排除同侧膝关节有既往手术史、膝关节严重内外翻畸形或严重关节外畸形、术前肌力和肌张力异常患者。患者按镇痛方案分为CFNB组和联合组；比较患者一般信息、手术时间、额外镇痛药物比例及下肢深静脉血栓(DVT)、留置管脱落、阻滞区域感染等并发症差异。分析术后12、24、48、72 h疼痛程度及股四头肌肌力差异。所得数据使用独立样本t检验、卡方检验、Kruskal-Wallis检验、Wilcoxon符号秩检验或方差分析进行统计学分析。

共纳入患者144例(CFNB组65例，联合组79例)。两组患者的一般信息、手术时间、额外镇痛药物比例和DVT发生率差异无统计学意义(均为P>0.05)；所有患者均未出现留置管脱落、阻滞区域感染等并发症。两组患者12 h和72 h自评视觉模拟评分(VAS)差异无统计学意义(P>0.05)。术后24 h和48 h，CFNB组VAS评分[(1.8±1.3)、(2.6±0.8)]低于联合组[(3.2±0.7)、(4.0±0.8)](t ＝－7.670、10.250，均为P<0.001)。两组患者术后12 h时的肌力差异无统计学意义(P>0.05)，CFNB组24、48、72 h的肌力低于联合组(H＝62.944、88.486、120.694，均为P<0.01)。

在TKA术后早期，SFNB联合PAI可以达到与CFNB相同的临床镇痛效果，但联合组患者股四头肌肌力恢复更快，且DVT发生风险更小，是TKA术后可取的镇痛方式之一。

To explore the difference of pain and muscle strength between continuous femoral nerve block (CFNB)and single femoral nerve block combined (SFNB) with periarticular injection (PAI) in the early stage after total knee arthroplasty (TKA) and to evaluate their analgesic effect and performance in functional rehabilitation.

The data of the patients using continuous femoral nerve block and single femoral nerve block combined with periarticular injection after TKA in Peking University Third Hospital from January 2020 to December 2020 were retrospectively collected. The patients who underwent unilateral primary TKA with intraspinal anesthesia and perioperative management by the same surgical group were included. The patients who had knee surgery history, severe varus deformity, valgus deformity or extra-articular deformity, and abnormal muscle strength and muscle tension were excluded. The patients who met the inclusion criteria were divided into two groups according to analgesia plan: the CFNB group and the combined group. The differences of demographic data, surgical time and additional analgesic were studied between the two groups. Deep vein thrombosis (DVT) of lower extremity, accidental pullout of nerve block catheter, infection in the area of nerve block catheter and other complications during hospitalization were analyzed. The degrees of pain and muscle strength of quadriceps were recorded at 12, 24, 48 and 72h after surgery. Independent sample t test, chi-square test, Kruskal-Wallis test, Wilcoxon signed rank test or ANOVA test were used for statistical analysis.

A total of 144 patients were enrolled, including 65 patients in the CFNB group and 79 patients in the combined group. There was no statistically significant difference in demographic data, surgical time, additional analgesics and the incidence of DVT between the two groups (all P>0.05). No complication such as accidental pullout of nerve block catheter, infection in the area of nerve block catheter occurred. There was also no statistically significant difference in self-assessed visual analogue scale (VAS) scores between the two groups at 12 and 72h postoperatively (both P>0.05). The VAS scores of CFNB group[(1.8±1.3), (2.6±0.8)] were lower than those of combined group [(3.2±0.7), (4.0±0.8)]at 24 and 48 h postoperatively [t =-7.670, 10.250, both P<0.001]. There was no statistically significant difference in muscle strength of quadriceps between the two groups at 12h postoperatively (P>0.05). The muscle strength of quadriceps of CFNB group were lower than those of combined group at 24, 48 and 72h postoperatively (H=62.944, 88.486, 120.694, all P<0.01).

SFNB combined with PAI can achieve the same clinical analgesic effect as CFNB in the early postoperative stage after TKA, but the combined group patients have faster recovery of muscle strength of quadriceps and a lower risk of DVT, which is one of the desirable analgesic methods after TKA.