超声引导膝神经阻滞对全膝关节置换患者术后疼痛的影响

doi:10.6040/j.issn.1671-7554.0.2024.0349

摘要/Abstract

摘要： 目的比较超声引导膝神经阻滞(genicular nerve block, GNB)与局部浸润镇痛(local infiltration analgesia, LIA)对全膝关节置换(total knee arthroplasty, TKA)术后疼痛的影响。方法全身麻醉下接受单侧全膝关节置换术患者60例,随机分为LIA组和GNB组,每组30例。GNB组在全麻诱导后,超声引导下行5条膝神经阻滞(0.2%罗哌卡因20 mL);LIA组在手术结束前接受关节周围局部浸润镇痛(0.2%罗哌卡因100 mL)。主要结局是术后24 h静息时的疼痛数字评分(numeric rating scale, NRS);次要结局包括术后静息(6、48 h)和运动时(6、24、48 h)的疼痛评分、术后24 h和48 h的舒芬太尼消耗量、术后24 h步行20 m用时、术后48 h恶心/呕吐发生率、患者满意度及住院时间等。结果与LIA组相比,GNB组患者术后24 h静息(3.6±1.0 vs. 2.4±0.8,P<0.001)和运动(5.4±1.4 vs. 3.9±1.1,P<0.001)疼痛评分以及术后48 h静息(4.2±1.2 vs. 3.4±0.9,P=0.010)和运动(5.7±1.4 vs. 4.4±1.2,P<0.001)疼痛评分显著降低。GNB组术后24 h［56.9(49.2,62.4) vs. 43.1(38.5,48.1),P<0.001］、48 h［90.4(85.1,105.5)vs. 81.7(75.9,90.6),P=0.002］的舒芬太尼用量,显著低于LIA组。两组在术后6 h疼痛评分、术后24 h步行20 m用时、术后48 h内恶心/呕吐发生、满意度评分及住院时间方面均差异无统计学意义(P>0.05)。结论与LIA相比,超声引导GNB可显著缓解TKA患者术后24、48 h的疼痛程度,并减少术后48 h的阿片类药物消耗量。

关键词: 全膝关节置换, 局部浸润镇痛, 膝神经阻滞, 加速康复, 术后疼痛

Abstract: Objective To evaluate the analgesic effect of ultrasound-guided genicular nerve block(GNB)and local infiltration analgesia(LIA)after total knee arthroplasty(TKA). Methods A total of 60 patients undergoing unilateral TKA under general anesthesia were randomsied into LIA and GNB groups, with 30 patients in each group. After induction of general anesthesia, the GNB group underwent ultrasound-guided GNB(20 mL of 0.2% ropivacaine)while the LIA group received periarticular LIA(100 mL of 0.2% ropivacaine)before the end of surgery. The primary outcome was the numerical rating scale(NRS)score at rest at 24 h postoperatively. Secondary outcomes included the NRS scores at rest(6, 48 h)and during movement(6, 24, 48 h), sufentanil consumption at 24 h and 48 h, 20 m walk test times at 24 h, nausea and vomiting at 48 h postoperatively, patient satisfaction and hospital stay. Results Compared to the LIA group, patients in the GNB group had significantly lower NRS scores at rest(3.6±1.0 vs. 2.4±0.8, P<0.001)and during movement(5.4±1.4 vs. 3.9±1.1, P<0.001)at 24 h postoperatively and at rest(4.2±1.2 vs. 3.4±0.9, P=0.010)and during movement(5.7±1.4 vs. 4.4±1.2, P<0.001)at 48 h postoperatively. Sufentanil consumption in the GNB group was significantly lower than in the LIA group at both 24 h ［(56.9(49.2-62.4)vs. 43.1(38.5-48.1), P<0.001］ and 48 h ［90.4(85.1-105.5) vs. 81.7(75.9-90.6), P=0.002］ postoperatively. The two groups showed no significant difference in NRS score at 6 h postoperatively, nausea and vomiting within 48 h, 20 m walk test times at 24 h, satisfaction scores and hospital stay(P>0.05). Conclusion Compared with LIA, ultrasound-guided GNB can significantly reduce pain scores and opioid consumption at 24 and 48 h postoperatively in TKA patients.

Key words: Total knee arthroplasty, Local infiltration analgesia, Genicular nerve block, Enhanced recovery after surgery, Postoperative pain

中图分类号:

R614

李雪,张增臻,刘吉松,李德强,杨绍忠. 超声引导膝神经阻滞对全膝关节置换患者术后疼痛的影响[J]. 山东大学学报 (医学版), 2024, 62(10): 68-75.

LI Xue, ZHANG Zengzhen, LIU Jisong, LI Deqiang, YANG Shaozhong. Effect of ultrasound-guided genicular nerve block on postoperative pain in patients undergoing total knee arthroplasty[J]. Journal of Shandong University (Health Sciences), 2024, 62(10): 68-75.

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