1 保定市第一中心医院麻醉科，河北 保定 071000
目的：观察收肌管阻滞不同输注方式用于全膝关节置换术后的镇痛效果。方法：拟行全膝关节置换术患者60例，美国麻醉医师学会(American Society of Anesthesiologists，ASA)II或III级，年龄65~77岁，随机分为2组(n=30)：程序间歇式输注组(P组)和恒速输注组(C组)。术毕给予负荷剂量0.2%罗哌卡因10 mL，并连接患者自控神经阻滞镇痛泵。P组程序间歇输注，单次自动给药剂量为10 mL，间歇时间为2 h。C组持续输注，背景剂量为5 mL/h。两组患者单次按压剂量为5 mL，锁定时间为30 min。当视觉模拟评分(Visual Analogue Scale，VAS)>4时，按压镇痛泵。若30 min后无缓解，皮下注射盐酸羟考酮5 mg，进行镇痛补救。分别于术后4、8、24、48和72 h时评估患者疼痛程度及患肢股四头肌肌力，并记录术后1~3 d患者步行距离。记录术后72 h内镇痛补救情况、患者满意度评分及不良反应发生情况。结果：与C组比较，P组患者8~48 h动态VAS评分降低(P<0.05)，P组术后1~3 d患者步行距离增加(P<0.05)。两组股四头肌肌力、镇痛补救率、患者满意度及不良反应发生率差异无统计学意义(P>0.05)。结论：程序间歇式输注收肌管阻滞可有效用于全膝关节置换术后镇痛，抑制动态痛效果优于恒速输注方式。
Analgesic effect of adductor canal block with different infusion methods for patients undergoing total knee arthroplasty
CorrespondingAuthor: WANG Chunguang
This work was supported by the Project on Medical Science Research Plan of Heibei Province, China (20191236).
Objective: To compare the analgesic effect of adductor canal block with different infusion methods for patients undergoing total knee arthroplasty. Methods: A total of 60 elderly patients undergoing total knee arthroplasty, aged 65–77 years, with American Society of Anesthesiologists (ASA) II or III, were randomly divided into two groups (n=30): a programmed intermittent bolus infusion group (Group P) and a constant infusion group (Group C). After the operation, a loading dose of 10 mL of 0.2% ropivacaine was given, and patient-controlled nerve block analgesia pump was connected. Programmed intermittent bolus infusion with a single automatic dose of 10 mL and intermittent time of 2 hours was used in Group P. Constant infusion with a background dose of 5 mL/h was used in Group C. The single patient pressing dose was 5 mL with a 30-minute locking time in both groups. When Visual Analog Scale (VAS) score was over 4 points, the analgesia pump was pressed. If pain was not relieved 30 minutes after pressing by patients, oxycodone hydrochloride of 5 mg was subcutaneously injected as analgesic remedy. VAS and quadriceps strength were recorded 4, 8, 24, 48 and 72 hours after surgery. The walking distance was recorded on day 1–3 after total knee arthroplasty (TKA). The analgesic remedy, patient satisfaction and adverse reactions were recorded within 72 hours after surgery. Results: Compared with Group C, the the dynamic VAS score between 8 hours and 48 hours after surgery was lower in Group P (P<0.05). Compared with Group C, the walking distance on day 1–3 was increased in Group P (P<0.05). But the quadriceps strength, analgesic remedy, patient satisfaction and the incidence of adverse reactions were not significantly different between Group P and Group C (P>0.05). Conclusion: Adductor canal block with programmed intermittent bolus infusion is effective for postoperative analgesia for patients undergoing total knee arthroplasty, and its effect of inhibiting dynamic pain is better than that of constant infusion.
programmed intermittent bolus infusion; constant infusion; adductor canal block; total knee arthroplasty