目的：评价帕瑞昔布钠对全膝关节置换术后连续股神经阻滞的镇痛效果及对早期膝关节功能恢复的影响。方法2012年5～12月择期行全膝关节置换术患者100例，于腰麻硬膜外联合麻醉前行连续股神经阻滞并用于术后镇痛。患者以随机、双盲形式分为2组：连续股神经镇痛组（ C组）和帕瑞昔布钠联合连续股神经镇痛组（ P组），P组于切皮前30 min和术后12、24、36和48 h静脉注射帕瑞昔布钠40 mg，C组给予等量生理盐水。术后对2组静息和被动运动时膝关节前后部疼痛视觉模拟评分（ visual analogue scale ，VAS）、镇痛泵按压次数、主动直腿抬高时间、被动屈膝90°时间、术前及术后72 h美国特种外科医院膝关节评分（ Hospital for Special Surgery Knee Score ，HSS）进行评估。结果静息时膝关节前部VAS评分各时点2组相似（P＞0．05），后部VAS评分在术后8、12、24、48 h时P组比C组降低（P＜0．05）；膝关节被动运动时前部VAS评分在24、48 h时P组比C组降低（P＜0．05），后部VAS评分在24 h时P组比C组降低（P＜0．05）；镇痛泵按压次数在术后4～8 h及8～12 h时间段P组比C组减少（P＜0．05）；2组术前、术后72 h HSS评分差异无显著性（P＞0．05）；主动直腿抬高时间、被动屈膝90°时间P组比C组缩短（P＜0．05）。结论帕瑞昔布钠对全膝关节置换术后连续股神经阻滞的患者在一定程度上缓解疼痛，缩短主动直腿抬高时间、被动屈膝90°时间从而部分改善早期膝关节功能，具有较好的促进恢复作用。%Objective To investigate the effects of parecoxib sodium on continuous femoral nerve block ( CFNB) analgesia and early rehabilitation training after total knee arthroplasty ( TKA) . Methods A total of 100 patients undergoing elective TKA from May 2012 to December 2012 were enrolled in this randomized , double blind , placebo controlled study .All patients received CFNB before combined spinal epidural anesthesia .They were randomly divided into 2 groups (n=50 each):CFNB (group C) and parecoxib sodium with CFNB (group P).Group P received parecoxib sodium 40 mg before incision and 12, 24, 36, 48 h after operation, while the equal volume of normal saline was used instead of parecoxib sodium in group C .Postoperative pain during rest and passive exercises including front and rear portions of knees using visual analogue scale ( VAS ) , the number of attempt PCA ( patient controlled analgesia), the time to perform an active straight leg raise , the time to reach 90 degree knee flexion passively , and preoperative and postoperative HSS scores (Hospital for Special Surgery Knee Score ) were evaluated. Results All patients in both groups had similar reduced rest pain in the front of knees , but VAS scores at the back of knees were significantly lower in group P at 8, 12, 24 and 48 h postoperatively when compared with group C (P<0.05).During passive exercises, VAS scores in the front of knees at 24, 48 h and in the back of knees at 24 h postoperatively were reduced significantly in group P when compared with group C (P<0.05).The number of attempt PCA in group P was less than that in group C during 4-8 h and 8-12 h postoperatively(P<0.05).There was no significant difference in preoperative and postoperative HSS scores (P>0.05) between the two groups.Compared with group C, the time to perform an active straight leg raise and the time to reach 90 degree knee flexion passively were significantly decreased in group P ( P<0.05). Conclusion Parecoxib sodium can to some extent improve CFNB analgesia , and shorten the time to perform active straight leg raise and to reach 90 degree knee flexion , consequently improving early-stage knee joint function and resulting in better recovery .
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