全膝关节置换膝关节周围混合药物注射与神经阻滞的镇痛效果比较

发布时间：2018-11-27 21:45

【摘要】：背景:目前对于膝关节周围混合药物注射的研究主要集中在术后镇痛方面,较少涉及到术后膝关节活动度及引流量等指标,而且与神经阻滞对比的研究较少。目的:比较膝关节周围注射混合药物与神经阻滞在全膝关节置换中的镇痛作用。方法:纳入于2016-06-01/10-31在安徽医科大学第一附属医院行初次单侧全膝关节置换的患者58例,按镇痛方案分成2组,每组29例。关节注射组全膝关节置换术中在膝关节周围注射混合药物100 m L(罗哌卡因、肾上腺素、吗啡、生理盐水);神经阻滞组于术前行股神经、坐骨神经联合阻滞。比较2组术后疼痛目测类比评分、术后膝关节活动度、术后引流量、术后住院时间、术后补救性镇痛患者的分布情况及不良反应发生情况等。结果与结论:(1)术后第3天静息性目测类比评分关节注射组较神经阻滞组低,差异有显著性意义(P0.05);(2)术后第1,2,3天运动性目测类比评分关节注射组较神经阻滞组低,差异有显著性意义(P0.05);(3)对于术后关节活动度以及术后引流量,术后住院时间、术后补救性镇痛患者的分布情况2组患者差异无显著性意义(P0.05);(4)2组患者术后均无明显恶心、呕吐等不适反应及并发症发生;(5)结果表明,全膝关节置换膝关节周围注射混合药物的镇痛效果优于神经阻滞,而且关节周围注射操作简单、方便,经济实用。
[Abstract]:Background: at present, the research on the injection of mixed drugs around the knee joint is mainly focused on postoperative analgesia, less on the index of postoperative knee motion and drainage, and less on the comparison with nerve block. Objective: to compare the analgesic effect of peri-knee injection and nerve block in total knee arthroplasty. Methods: a total of 58 patients with primary unilateral total knee arthroplasty were enrolled in the first affiliated Hospital of Anhui Medical University in 2016-06-01 / 10-31. They were divided into two groups according to the analgesic scheme, 29 cases in each group. M L (ropivacaine, epinephrine, morphine and normal saline were injected into the knee around the knee in the total knee arthroplasty group, and the combined femoral nerve and sciatic nerve block were performed in the nerve block group before operation. The visual analogue score of postoperative pain, postoperative knee motion, postoperative drainage, postoperative hospitalization time, distribution of postoperative relief analgesia and adverse reactions were compared between the two groups. Results and conclusion: (1) on the 3rd day after operation, the visual analogue score of the joint injection group was lower than that of the nerve block group, and the difference was significant (P0.05). (2) the motor visual analogue score was significantly lower in the joint injection group than in the nerve block group on the 3rd day after operation (P0.05). (3) there was no significant difference between the two groups in terms of postoperative joint motion, postoperative drainage, postoperative hospitalization time and postoperative relief analgesia (P0.05). (4) there were no significant postoperative nausea, vomiting and complications in both groups. (5) the results showed that the analgesic effect of total knee arthroplasty was better than that of nerve block, and the operation of periarticular injection was simple, convenient, economical and practical.
【作者单位】：安徽医科大学第一附属医院;
【分类号】：R687.4

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