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| 连续髂筋膜间隙阻滞对全膝关节置换术术后疼痛和早期运动的影响 |
| Effects of continuous fascia iliac compartment block on postoperative pain and early movement after total knee arthroplasty |
| 投稿时间：2022-01-29 |
| DOI：10.3969/j.issn.1000-0399.2022.06.003 |
| 中文关键词: 髂筋膜间隙阻滞 全膝关节置换术 疼痛 |
| 英文关键词: Fascia iliac compartment block Total knee arthroplasty Pain |
| 基金项目:安徽省重点研究与开发计划项目(项目编号:1804h08020286),吴阶平医学基金会临床科研专项资助基金(项目编号:320.6750.16166) |
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| 中文摘要: |
| 目的 比较超声引导下腹股沟上连续髂筋膜间隙阻滞(FICB)和静脉镇痛(PCIA)对单侧全膝关节置换术(TKA)患者术后疼痛和早期运动的影响。方法 选择2021年5~10月安徽医科大学附属省立医院择期首次行TKA患者80例,患者采用相同麻醉方案,采用随机数字表法分为静脉镇痛组(PCIA组)和连续腹股沟上髂筋膜间隙阻滞组(FICB组),每组各40例。PCIA组术后立即接静脉镇痛泵(舒芬太尼2 μg/kg,氟哌利多5 mg,加生理盐水至100 mL);FICB组麻醉前在超声引导下行腹股沟上FICB并置管,术后立即接镇痛泵(0.2%罗哌卡因300 mL)。比较两组患者临床指标、静息及术后5米步行试验数字评分量表(NRS)评分、术后24和48小时Bromage肌力、术后曲马多补救镇痛用量及不良反应情况。结果 两组患者手术时间、麻醉时间、驱血带时间、麻醉恢复室(PACU)停留时间、术中丙泊酚用量比较,差异均无统计学意义(P>0.05);与PCIA组相比,FICB组术中瑞芬太尼用量、镇痛泵按压次数、曲马多用量、首次下床活动时间、术后住院时间,术后24、48小时5米步行试验NRS评分减少或降低,差异均有统计学意义(P<0.05)。两组术后6、48小时静息NRS评分和Bromage肌力,差异无统计学意义(P>0.05)。结论 超声引导下腹股沟上连续FICB能有效控制TKA术后运动痛,使患者能够早期下床活动,减少围术期阿片类药物用量,加速患者康复。 |
| 英文摘要: |
| Objective To compare the effects of ultrasound-guided continuous supra-inguinalfascia iliac compartment block(FICB)with patient-controlled intravenous analgesia (PCIA) for pain control and early movement in patients after unilateral total knee arthroplasty (TKA). Methods Eighty patients who underwent elective TKA for the first time in Affiliated Provincial Hospital of Anhui Medical University from May to October 2021 were selected and randomly divided into patient-controlled intravenous analgesia (group PCIA) and continuous supra-inguinal fascia iliac compartment block (group FICB).The two groups used the same anesthesia plan. Group PCIA was connected with intravenous analgesia pump(sufentanil 2 μg/kg+ droperidol 5 mg+ saline diluted to 100 mL) after operation. In group FICBfascia iliac compartment was inserted the catheter on the groin under ultrasound guidance on the operative side before anesthesia, and the analgesic pump (300 mL 0.2% ropivacaine) was connected postoperatively. Clinical indicators, numerical rating scale (NRS) scores inrestingandin 5-meter walk test 24 and 48 hours postoperatively, Bromage scales and adverse reactions were compared between two groups.Results There was no significant difference in duration of surgery, anesthesia, tourniquet, PACU stays and intraoperative propofol dosage between the two groups (P＞0.05). Compared with group PCIA, intraoperative remifentanil, number of analgesic pump presses, tramadol dosage, time to get out of bed for the first time, postoperative hospital stays and NRS scores in 5-meter walk test at 24 and 48 hours after surgery ingroup FICB were remarkably lower (P＜0.05). Bromage scales in 24 and 48 hours postoperatively and NRS scores in resting at 6 and 48 hours after surgery showed no notably differences (P＞0.05). Conclusions Ultrasound-guided continuous supra-inguinal FICB can effectively control postoperative movement pain, enable patients to get out of bed early, reduce the perioperative opioid dosage and accelerate the recovery of patients. |
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