| 神经阻滞在前交叉韧带重建术后早期镇痛中的临床应用 |
|
摘要点击次数: 893
全文下载次数: 83
投稿时间：2024-11-11
|
| 作者 | Author | 单位 | Address | E-Mail |
| 刘丙根 |
LIU Bing-gen |
宜春市人民医院骨科, 江西 宜春 336000 |
Department of Orthopaedics, Yichun People's Hospital, Yichun 336000, Jiangxi, China |
450413369@qq.com |
| 陈思锋 |
CHEN Si-feng |
宜春市人民医院骨科, 江西 宜春 336000 |
Department of Orthopaedics, Yichun People's Hospital, Yichun 336000, Jiangxi, China |
|
| 张催 |
ZHANG Cui |
宜春市人民医院骨科, 江西 宜春 336000 |
Department of Orthopaedics, Yichun People's Hospital, Yichun 336000, Jiangxi, China |
|
| 雷鸣 |
LEI Ming |
宜春市人民医院骨科, 江西 宜春 336000 |
Department of Orthopaedics, Yichun People's Hospital, Yichun 336000, Jiangxi, China |
|
| 张管 |
ZHANG Guan |
宜春市人民医院麻醉科, 江西 宜春 336000 |
Department of Anesthesiology, Yichun People's Hospital, Yichun 336000, Jiangxi, China |
|
|
| 期刊信息：《中国骨伤》2025年，第38卷，第3期，第287-292页 |
| DOI：10.12200/j.issn.1003-0034.20230354 |
| 基金项目:江西省科技计划项目(编号:202312217) |
|
中文摘要:
目的: 探讨前交叉韧带(anterior cruciate ligament,ACL)重建术采用蛛网膜下腔阻滞(subarachnoid block,SA)、收肌管神经阻滞(adductor canal block,ACB)与股神经阻滞(femoral nerve block,FNB)早期镇痛的有效性与安全性。
方法: 自2022年9月至2023年10月选取接受单侧膝关节镜下ACL重建术治疗的90例ACL断裂患者,按照麻醉方式不同分为ACB组、FNB组和SA组,每组30例。ACB组男12例,女18例;年龄18~60(33.3±13.8)岁;美国麻醉医师协会(American Society of Aneshesiologists,ASA)分级Ⅰ级14例,Ⅱ级16例;左侧13例,右侧17例。FNB组男15例,女15例;年龄18~60(33.5±12.9)岁;ASA分级Ⅰ级15例,Ⅱ级15例;左侧16例,右侧14例。SA组男16例,女14例;年龄18~60(31.0±12.6)岁;ASA分级Ⅰ级18例,Ⅱ级12例;左侧17例,右侧13例。ACB、FNB组在SA麻醉前行超声引导下行ACB和FNB神经阻滞,用药为0.3%罗哌卡因15 ml。分别记录并比较术后4、8、12、16、24、48 h时3组静息状态和被动运动时疼痛视觉模拟评分(visual analogue scale,VAS)及股四头肌肌力情况,术后48 h内曲马多用量、恶心呕吐发生率、神经阻滞时间及其他并发症。
结果: 所有患者获得随访,时间11~20(15.8±2.4)个月。SA组术后4、8、12、16、24及48 h静息和被动运动VAS明显高于ACB组和FNB组,差异有统计学意义(P<0.05);ACB组术后4、8、12、16、24及48 h静息和被动运动VAS与FNB组比较,差异无统计学意义(P>0.05)。术后4、8、12、16 h,SA组和ACB组股四头肌肌力高于FNB组,差异有统计学意义(P<0.05);但术后24、48 h,3组股四头肌肌力两两比较,差异无统计学意义(P>0.05)。ACB组术后1例发生恶心呕吐,FNB组2例,SA组5例;3组比较差异无统计学意义(χ2=0.352,P=0.171)。SA组术后曲马多用量为(300.00±136.50) mg,高于FNB组(168.33±73.70) mg和ACB (163.33±70.70) mg,差异有统计学意义(P<0.05)。ACB组和FNB组神经阻滞时间比较差异无统计学意义(P>0.05)。3组均未出现穿刺部位出血、局麻药物中毒、血肿形成。
结论: FNB和ACB均可提供良好的ACL重建术后早期镇痛,但ACB组对股四头肌肌力影响小,患者能在无痛下及早进行术后功能训练,更有利于膝关节功能的恢复,可以减少镇痛药物的使用,无严重并发症发生,安全可靠。 |
| 【关键词】收肌管神经阻滞 股神经阻滞 前交叉韧带重建术 镇痛效果 |
| |
| Clinical application of nerve block in early analgesia after anterior cruciate ligament reconstruction |
|
ABSTRACT
Objective To explore clinical effective and safety of subarachnoid block (SA),adductor canal block (ACB),and femoral nerve block (FNB) for early analgesia in anterior cruciate ligament (ACL) reconstruction.
Methods From September 2022 to October 2023,90 patients with ACL rupture who received unilateral knee arthroscopic ACL reconstruction were selected and divided into ACB group,FNB group and SA group according to different anesthesia methods,with 30 patients in each group. There were 12 males and 18 females in ACB group,aged from 18 to 60 years old with an average of (33.3±13.8) years old;14 patients with gradeⅠand 16 patients with gradeⅡaccording to American Society of Aneshesiologists (ASA);13 patients on the left side and 17 patients on the right side. There were 15 males and 15 females in FNB group,aged from 18 to 60 years old with an average of (33.5±12.9) years old;15 patients with gradeⅠand 15 patients with gradeⅡ;16 patients on the left side and 14 patients on the right side. There were 16 males and 14 females in SA group,aged from 18 to 60 years old with an average of (31.0±12.6) years old;18 patients with grade I and 12 patients with gradeⅡ;17 patients on the left side and 13 patients on the right side. In ACB and FNB groups,the nerve block of ACB and FNB were performed under ultrasound guidance before SA anesthesia with 15 ml of 0.3% ropivacaine. Visual analogue scale (VAS) and quadriceps muscle strength at rest and passive movement were recorded and compared among 3 groups at 4,8,12,16,24 and 48 h after operation,as well as the dosage of tramadol injection analgesics,incidence of nausea and vomiting,nerve block time and other complications within 48 h after operation were compared.
Results All patients were followed up for 11 to 20 (15.8±2.4) months. VAS at 4,8,12,16,24 and 48 h after operation of SA group was significantly higher than that of ACB and FNB groups,with statistical significance (P<0.05). There were no significant difference in VAS of rest and passive movement at 4,8,12,16,24 and 48 h after operation between ACB group and FNB group(P>0.05). At 4,8,12 and 16 h after operation,the quadriceps muscle strength in SA and ACB groups was higher than that in FNB group,with statistical significance (P<0.05);but there was no statistical significance in quadriceps muscle strength among three groups at 24 and 48 h after operation(P>0.05). One patient occurred nausea and vomiting in ACB group,2 patients in FNB group and 5 patients in SA group,and no significant difference among three groups (χ2=0.352,P=0.171). The dosage of tramadol in SA group was (300.00±136.50) mg,which was higher than that in FNB group (168.33±73.70) mg and ACB(163.33±70.70) mg,and the difference was statistically significant (P<0.05). There was no significant difference in nerve block time between ACB group and FNB group (t=1.964,P=0.054). There was no puncture site bleeding,local anesthesia drug poisoning and hematoma formation among three groups.
Conclusion Both FNB and ACB could provide good early analgesia after ACL reconstruction,but ACB group has little effect on quadriceps muscle strength. Patients could have early postoperative functional training without pain,which is more beneficial to the recovery of knee joint function,and could reduce the use of analgesic drugs,without serious complications,which is safe and reliable method. |
| KEY WORDS Adductor block Femoral nerve block Anterior cruciate ligament reconstruction Analgesic effect |
| |
| 引用本文，请按以下格式著录参考文献： |
| 中文格式: | 刘丙根,陈思锋,张催,雷鸣,张管.神经阻滞在前交叉韧带重建术后早期镇痛中的临床应用[J].中国骨伤,2025,38(3):287~292 |
| 英文格式: | LIU Bing-gen,CHEN Si-feng,ZHANG Cui,LEI Ming,ZHANG Guan.Clinical application of nerve block in early analgesia after anterior cruciate ligament reconstruction[J].zhongguo gu shang / China J Orthop Trauma ,2025,38(3):287~292 |
|
| 阅读全文 下载 查看/发表评论 下载PDF阅读器 |
| 关闭 |
|
|
|
