膝关节置换术中单次股神经阻滞与局部浸润镇痛的效果对比研究
发布时间：2019-07-04 06:26
【摘要】：目的拟通过对比单次股神经阻滞与切口局部浸润局麻药这两种镇痛方法分别联合口服非甾体抗炎药及术后冷疗所构成的两种多模式镇痛方案在全膝关节置换术中的疗效及对术后并发症的影响，找到更佳的术后镇痛方案。 方法从2012年2月至2013年6月，搜集在我科拟行初次在初次单侧全膝关节置换术(total knee arthroplasty,TKA)的75例患者,均明确诊断为膝关节骨性关节炎（osteoarthritis，OA）。男性27例，，女性48例，患者年龄分布于53-81岁，其中女性均已绝经。所有患者具有明确的手术指征并排除相关手术禁忌症。运用前瞻性、随机性、对比研究方法在术前将75例患者随机分为三组，各25例。单次股神经阻滞组（F组）、局部浸润镇痛组（L组）和静脉镇痛泵组（I组）。三组麻醉方式均为静脉吸入复合全身麻醉。镇痛方案为：F组：术前及术后口服塞来昔布胶囊与曲马多缓释片+麻醉后罗哌卡因与肾上腺素单次股神经阻滞+术后冷疗；L组：术前及术后口服塞来昔布胶囊和曲马多缓释片+术中局部浸润注射罗哌卡因与肾上腺素混合物+术后冷疗；I组：术前不采取镇痛措施，术后应用静脉镇痛泵。记录并比较三组患者术后膝关节疼痛视觉模拟评分法（visual analogue scale，VAS）分数、吗啡追加量、主动直腿抬高至45°时间、主动屈曲至90°时间、出院时膝关节活动度（range of motion, ROM）、术后呼吸抑制、呕吐、尿储留的发生率。. 结果1. F组与L组相比，膝关节疼痛VAS评分、吗啡消耗量、主动直腿抬高至45°时间、主动屈曲至90°时间、出院时膝关节ROM无明显差异（P0.05），术后尿储留、呕吐发生率也相似（P0.05），且两组患者均未出现呼吸抑制。2.与I组相比，F组和L组吗啡追加量、术后前3天的膝关节疼痛VAS评分、主动直腿抬高至45°时间、主动屈曲至90°时间、术后呼吸抑制、呕吐和尿储留发生率均明显下降和减少（P0.05），出院时膝关节ROM增加，差异有统计学意义（P0.05）；而术后第4、5天，F组和L组与I组的膝关节疼痛VAS评分差异无统计学意义（P0.05）。 结论1.单次股神经阻滞和膝关节局部浸润镇痛在TKA中的镇痛效果相近，且均无明显并发症。2.罗哌卡因与肾上腺素单次股神经阻滞+手术前后口服塞来昔布胶囊与曲马多缓释片+术后冷疗所组成的多模式超前镇痛方案，或是术中局部浸润注射罗哌卡因与肾上腺素混合物+手术术后口服塞来昔布胶囊和曲马多缓释片+术后冷疗，均可取得较静脉镇痛泵更理想的镇痛效果，减少术后吗啡的使用量和相关副作用，促进患者更早的进行术后功能锻炼，加快功能恢复。
[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 掳time, active flexion to 90 掳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 掳, active flexion to 90 掳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 掳, the time of active flexion to 90 掳, 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.
【学位授予单位】：安徽医科大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R614
本文编号：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 掳time, active flexion to 90 掳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 掳, active flexion to 90 掳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 掳, the time of active flexion to 90 掳, 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.
【学位授予单位】：安徽医科大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R614
【参考文献】
相关期刊论文 前1条
1 翁文杰;王锋;张海林;蒋青;邱勇;;全膝关节置换术中关节周围注射混合镇痛液的疗效观察[J];中华关节外科杂志(电子版);2009年06期
本文编号：2509705
本文链接：https://www.wllwen.com/yixuelunwen/mazuiyixuelunwen/2509705.html
最近更新
教材专著
