摘要
目的 总结收肌管阻滞(adductor canal block,ACB)应用于膝关节置换术后镇痛效果的研究进展,以期发现获得更好临床效果的ACB方式。方法 广泛查阅近年来国内外关于ACB的相关文献,对ACB应用于膝关节置换术后镇痛效果的研究进展进行综述。结果 近年来,多模式镇痛已成为膝关节置换术后疼痛管理的主要方法,其中ACB能够提供等效、良好的镇痛效果,同时更好地保存股四头肌功能,替代了“金标准”股神经阻滞(femoral nerve block,FNB)。在临床操作中使用0.2%罗哌卡因行ACB,首次负荷剂量为15~30 mL,持续负荷剂量<8 mL/h,能够提供与FNB等效的镇痛效果,同时对下肢肌力影响较小,相对安全有效;但医务人员仍需警惕患者跌倒可能性。在采用局部麻醉药物行ACB中联合应用辅助药物如右美托咪定、地塞米松等,可增强术后镇痛效果、延长镇痛时间;1μg/kg右美托咪定神经周围给药可能同时兼顾安全性和镇痛疗效。结论 ACB是膝关节置换术后一种安全有效的镇痛方法。由于收肌管内神经结构的高度变异性,收肌管解剖、ACB的最佳阻滞方法和阻滞位置存在较大争议,仍需进一步研究与探讨。
Objective To summarize the research progress of the analgesic effect of adductor canal block(ACB) applied to knee arthroplasty, in order to find the ACB mode that can obtain better effectiveness. Methods The research progress of the analgesic effect of ACB after knee arthroplasty was reviewed by widely consulting the related literature on ACB at home and abroad in recent years. Results In recent years, multimodal analgesia has become the mainstay of postoperative pain management after knee arthroplasty. Among these, ACB replaces the once “gold standard” femoral nerve block(FNB) by offering comparable and effective analgesia with better preservation of quadriceps function. It is generally safe and efficient to use 0.2% ropivacaine ACB with initial loading doses of 15-30 mL and continual loading doses of less than 8 mL/hour to give analgesia comparable to FNB with minimal impact on lower extremity muscular strength. However, the risk of patient falls must still be taken into consideration by medical staff. Adjuvants like dexmedetomidine and dexamethasone used in ACB can increase the analgesic duration and postoperative analgesic impact. As a perineural adjunct for ACB, 1 μg/kg dexmedetomidine may strike a balance between safety and analgesic efficacy. Conclusion ACB is a safe and effective analgesia method after knee arthroplasty. The adductor canal anatomy,the optimum blocking strategy and blocking site of ACB are all hotly debated and still require additional study due to the significant variety of the nerve structures in adductor canal.
作者
刘典琦
温晓晖
卢伟杰
LIU Dianqi;WEN Xiaohui;LU Wejie(Department of Joint Surgery,the First Afiliated Hospital of Guangzhou Medical University,Guangzhou Guangdong,510120,P.R.China;Department of Anesthesiology,the First Affiliated Hospital of Guangzhou Medical University,Guangzhou Guangdong,510120,P.R.China)
出处
《中国修复重建外科杂志》
CAS
CSCD
北大核心
2023年第1期106-114,共9页
Chinese Journal of Reparative and Reconstructive Surgery
关键词
膝关节置换术
收肌管阻滞
镇痛
股四头肌
Knee arthroplasty
adductor canal block
analgesia
quadriceps muscle
