摘要
目的比较连续股神经阻滞镇痛（CFNB）与静脉镇痛（CIA）对全膝关节置换术患者术后镇痛效果。方法2008年1月至2009年11月北京积水潭医院126例拟行单侧膝关节置换术患者，数字随机分为两组，CIA组与CFNB组，每组63例。两组患者均使用腰硬联合麻醉。CIA组镇痛泵的配方为芬太尼30μg／kg，背景输注2ml／h。CFNB组，术毕连接镇痛泵持续输注0．2％罗哌卡因5ml／h。镇痛不足时由病房医生根据患者疼痛情况给予哌替啶50mg肌肉注射或者口服西乐葆200mg。CFNB组在联合麻醉前经股神经鞘放置导管并推注0．5％罗哌卡因20ml。记录术后静息状态下4、8、12、16、24、36、48h的疼痛评分和术后24、36、48h被动功能锻炼时疼痛评分及副作用和满意度。结果CFNB组的镇痛评分（视觉模拟评分VAS）不论是在静息状态下还是在功能锻炼时均比CIA组明显低（P〈0．01）。CIA组恶心、呕吐、头晕嗜睡发生率明显高于CFNB组。CFNB组患者对镇痛效果的满意度为92．1％，而CIA组的满意度为20．6％。结论CFNB可以为全膝关节置换术后患者提供比CIA更为满意的镇痛效果，其将成为全膝关节置换术后镇痛多模式镇痛策略中一种安全、有效和实用的方法。
Objective To compare the analgesic efficacy of continuous femoral nerve blockade （CFNB） and continuous intravenous analgesia（CIA） after total knee arthroplasty （TKA）. Methods 126 patients undergoing TKA under combined epidural-spinal anesthesia were randomized to receive either a femoral infusion of ropivacaine 0. 2% （median infusion rate 5 ml/h） （n = 63 ） or an intravenous infusion of fentanyl 30 μg/kg （2 ml/h） （n = 63 ）. Adjuvant analgesics were oral celebrex or IM pethidine. In the CFNB group, CFNB was established before combined epidural-spinal anesthesia and 20 ml 0. 5% ropivacaine was infused through the catheter placed near femoral nerve. Visual analogue scale （VAS） scores were assessed at rest and on passive mobilization by acute pain service blinded to analgesic treatment. Nausea and vomiting, dizziness, satisfaction and other side-effects were assessed postoperatively. Results There was significantly less VAS scores in the CFNB group comparing the CIA group at rest 4,8,12,16,24,36,48 h after surgery（P 〈0.01 ）. A significant difference in VAS scores was found in CFNB group vs CIA group on passive mobilization 24,36,48 h after operation（ P 〈 0. 01 ）. There was significantly less dizziness, nausea and vomiting in the CFNB group（P 〈0. 01 ）. Patient satisfaction was higher in the CFNB group（92. 1% ） than the CIA group （20. 6% ） （ P 〈 0. 01 ）. Conclusion CFNA with ropivacaine 0. 2% is more effective in controlling postoperative pain than CIA and CFNB is an effective regional component of a multimodal analgesic strategy after TKA.
出处
《中华医学杂志》
CAS
CSCD
北大核心
2010年第33期2360-2362,共3页
National Medical Journal of China
关键词
股神经
罗哌卡因
术后镇痛
全膝关节置换
Femoral nerve
Ropivacaine
Postoperative analgesia
Total knee arthroplasty
