膝關節(jié)置換術中單次股神經阻滯與局部浸潤鎮(zhèn)痛的效果對比研究
發(fā)布時間：2019-07-04 06:26
【摘要】：目的擬通過對比單次股神經阻滯與切口局部浸潤局麻藥這兩種鎮(zhèn)痛方法分別聯合口服非甾體抗炎藥及術后冷療所構成的兩種多模式鎮(zhèn)痛方案在全膝關節(jié)置換術中的療效及對術后并發(fā)癥的影響，找到更佳的術后鎮(zhèn)痛方案。 方法從2012年2月至2013年6月，搜集在我科擬行初次在初次單側全膝關節(jié)置換術(total knee arthroplasty,TKA)的75例患者,均明確診斷為膝關節(jié)骨性關節(jié)炎（osteoarthritis，OA）。男性27例，，女性48例，患者年齡分布于53-81歲，其中女性均已絕經。所有患者具有明確的手術指征并排除相關手術禁忌癥。運用前瞻性、隨機性、對比研究方法在術前將75例患者隨機分為三組，各25例。單次股神經阻滯組（F組）、局部浸潤鎮(zhèn)痛組（L組）和靜脈鎮(zhèn)痛泵組（I組）。三組麻醉方式均為靜脈吸入復合全身麻醉。鎮(zhèn)痛方案為：F組：術前及術后口服塞來昔布膠囊與曲馬多緩釋片+麻醉后羅哌卡因與腎上腺素單次股神經阻滯+術后冷療；L組：術前及術后口服塞來昔布膠囊和曲馬多緩釋片+術中局部浸潤注射羅哌卡因與腎上腺素混合物+術后冷療；I組：術前不采取鎮(zhèn)痛措施，術后應用靜脈鎮(zhèn)痛泵。記錄并比較三組患者術后膝關節(jié)疼痛視覺模擬評分法（visual analogue scale，VAS）分數、嗎啡追加量、主動直腿抬高至45°時間、主動屈曲至90°時間、出院時膝關節(jié)活動度（range of motion, ROM）、術后呼吸抑制、嘔吐、尿儲留的發(fā)生率。. 結果1. F組與L組相比，膝關節(jié)疼痛VAS評分、嗎啡消耗量、主動直腿抬高至45°時間、主動屈曲至90°時間、出院時膝關節(jié)ROM無明顯差異（P0.05），術后尿儲留、嘔吐發(fā)生率也相似（P0.05），且兩組患者均未出現呼吸抑制。2.與I組相比，F組和L組嗎啡追加量、術后前3天的膝關節(jié)疼痛VAS評分、主動直腿抬高至45°時間、主動屈曲至90°時間、術后呼吸抑制、嘔吐和尿儲留發(fā)生率均明顯下降和減少（P0.05），出院時膝關節(jié)ROM增加，差異有統(tǒng)計學意義（P0.05）；而術后第4、5天，F組和L組與I組的膝關節(jié)疼痛VAS評分差異無統(tǒng)計學意義（P0.05）。 結論1.單次股神經阻滯和膝關節(jié)局部浸潤鎮(zhèn)痛在TKA中的鎮(zhèn)痛效果相近，且均無明顯并發(fā)癥。2.羅哌卡因與腎上腺素單次股神經阻滯+手術前后口服塞來昔布膠囊與曲馬多緩釋片+術后冷療所組成的多模式超前鎮(zhèn)痛方案，或是術中局部浸潤注射羅哌卡因與腎上腺素混合物+手術術后口服塞來昔布膠囊和曲馬多緩釋片+術后冷療，均可取得較靜脈鎮(zhèn)痛泵更理想的鎮(zhèn)痛效果，減少術后嗎啡的使用量和相關副作用，促進患者更早的進行術后功能鍛煉，加快功能恢復。
[Abstract]:Objective to compare the curative effect and postoperative complications of two kinds of analgesic schemes, single thigh nerve block and incision local infiltration local anesthetic, combined with oral non-steroidal anti-inflammatory drugs and postoperative cold therapy, respectively, and to find a better postoperative analgesia scheme. Methods from February 2012 to June 2013, 75 patients with knee osteoarthritis (osteoarthritis,OA) were diagnosed as knee osteoarthritis (osteoarthritis,OA) for the first time in our department. There were 27 males and 48 females. The patients were 53 years old and 81 years old, all of them were menopausal. All patients have clear surgical indications and exclude related contraindications. Using prospective, random and comparative study, 75 patients were randomly divided into three groups, 25 patients in each group. Single thigh nerve block group (group F), local infiltration analgesia group (group L) and intravenous analgesia pump group (group I). All the three groups were anesthetized by intravenous inhalation combined with general anesthesia. The analgesic regimen was as follows: group F: cold therapy with ropivacaine and epinephrine after anesthesia with celecoxib capsule and tramadol sustained-release tablets before and after operation; group L: local infiltration injection of ropivacaine and epinephrine mixture before and after operation; group I: intravenous analgesia pump was not taken before operation. The scores of (visual analogue scale,VAS), morphine addition, active straight leg elevation to 45 擄time, active flexion to 90 擄time, and the incidence of respiratory suppression, vomiting and urine storage after (range of motion, ROM), were recorded and compared among the three groups. Results 1. Compared with group L, there was no significant difference in VAS score of knee joint pain, morphine consumption, active straight leg elevation to 45 擄, active flexion to 90 擄time, no significant difference in ROM of knee joint at discharge (P 0.05), and the incidence of postoperative urine storage and vomiting was similar (P 0.05), and there was no respiratory inhibition in both groups. 2. Compared with group I, the amount of morphine in group F and group L, the VAS score of knee joint pain, the time of active straight leg elevation to 45 擄, the time of active flexion to 90 擄, the incidence of postoperative respiratory suppression, vomiting and urinary storage decreased significantly in group F and L, and the ROM of knee joint increased at discharge (P 0.05). On the 4th and 5th day after operation, there was no significant difference in VAS score between group F, group L and group I (P 0.05). Conclusion 1. The analgesic effect of single thigh nerve block and knee joint local infiltration analgesia in TKA was similar, and there were no obvious complications. 2. The multi-mode preemptive analgesia regimen composed of ropivacaine and epinephrine single thigh nerve block before and after oral celecoxib capsule and tramadol sustained-release tablets after operation, or intraoperative local infiltration injection of ropivacaine and epinephrine mixture after operation, can achieve better analgesic effect than intravenous analgesia pump. Reduce postoperative morphine use and related side effects, promote patients to carry out postoperative functional exercise earlier, accelerate functional recovery.
【學位授予單位】：安徽醫(yī)科大學
【學位級別】：碩士
【學位授予年份】：2014
【分類號】：R614
本文編號：2509705
[Abstract]:Objective to compare the curative effect and postoperative complications of two kinds of analgesic schemes, single thigh nerve block and incision local infiltration local anesthetic, combined with oral non-steroidal anti-inflammatory drugs and postoperative cold therapy, respectively, and to find a better postoperative analgesia scheme. Methods from February 2012 to June 2013, 75 patients with knee osteoarthritis (osteoarthritis,OA) were diagnosed as knee osteoarthritis (osteoarthritis,OA) for the first time in our department. There were 27 males and 48 females. The patients were 53 years old and 81 years old, all of them were menopausal. All patients have clear surgical indications and exclude related contraindications. Using prospective, random and comparative study, 75 patients were randomly divided into three groups, 25 patients in each group. Single thigh nerve block group (group F), local infiltration analgesia group (group L) and intravenous analgesia pump group (group I). All the three groups were anesthetized by intravenous inhalation combined with general anesthesia. The analgesic regimen was as follows: group F: cold therapy with ropivacaine and epinephrine after anesthesia with celecoxib capsule and tramadol sustained-release tablets before and after operation; group L: local infiltration injection of ropivacaine and epinephrine mixture before and after operation; group I: intravenous analgesia pump was not taken before operation. The scores of (visual analogue scale,VAS), morphine addition, active straight leg elevation to 45 擄time, active flexion to 90 擄time, and the incidence of respiratory suppression, vomiting and urine storage after (range of motion, ROM), were recorded and compared among the three groups. Results 1. Compared with group L, there was no significant difference in VAS score of knee joint pain, morphine consumption, active straight leg elevation to 45 擄, active flexion to 90 擄time, no significant difference in ROM of knee joint at discharge (P 0.05), and the incidence of postoperative urine storage and vomiting was similar (P 0.05), and there was no respiratory inhibition in both groups. 2. Compared with group I, the amount of morphine in group F and group L, the VAS score of knee joint pain, the time of active straight leg elevation to 45 擄, the time of active flexion to 90 擄, the incidence of postoperative respiratory suppression, vomiting and urinary storage decreased significantly in group F and L, and the ROM of knee joint increased at discharge (P 0.05). On the 4th and 5th day after operation, there was no significant difference in VAS score between group F, group L and group I (P 0.05). Conclusion 1. The analgesic effect of single thigh nerve block and knee joint local infiltration analgesia in TKA was similar, and there were no obvious complications. 2. The multi-mode preemptive analgesia regimen composed of ropivacaine and epinephrine single thigh nerve block before and after oral celecoxib capsule and tramadol sustained-release tablets after operation, or intraoperative local infiltration injection of ropivacaine and epinephrine mixture after operation, can achieve better analgesic effect than intravenous analgesia pump. Reduce postoperative morphine use and related side effects, promote patients to carry out postoperative functional exercise earlier, accelerate functional recovery.
【學位授予單位】：安徽醫(yī)科大學
【學位級別】：碩士
【學位授予年份】：2014
【分類號】：R614
【參考文獻】
相關期刊論文 前1條
1 翁文杰;王鋒;張海林;蔣青;邱勇;;全膝關節(jié)置換術中關節(jié)周圍注射混合鎮(zhèn)痛液的療效觀察[J];中華關節(jié)外科雜志(電子版);2009年06期
本文編號：2509705
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