超声联合神经刺激器引导连续股神经阻滞用于全膝关节置换术后镇痛的对比研究

摘要

Objective To investigate the efficiency of ultrasonography combined with nerve stimulation guidance for continuous femoral nerve block. Methods In September 2010, we performed continuous femoral nerve block under the guidance by ultrasonography combined with nerve stimulation in 22 patients ( C + S group) for postoperative and rehabilitation pain control after total knee arthroplasty (TKA), at the same time another 23 patients received nerve stimulation guidance (S group) only. The analgesic effect and complications were compared between the two groups. Results C + S group had significantly shorter operation time and less cases of subcutaneous congestion in the puncture site [ (6.3 ± 3.0) min vs. ( 11.5 ± 7.0) min, t = - 3. 212, P = 0.002; 5 vs.0 cases, P = 0. 049]. No significant difference was found in the analgesic effect at 15 minutes after injection of 20 ml 0.25％ropivacaine (Z = - 0. 462, P = 0. 644), nor in the postoperative RVAS, IVAS, and PVAS ( P ＞ 0.05 ). In C + S group, 4 patients received single injection of lidocaine through the femoral nerve catheter, which was not significantly less than that in S group (5 cases,x2 = 0. 000, P = 1. 000). During the first 72 hours postoperation, the two groups showed no significant difference in the requirement for pethidini ( Z = - 0. 069, P = 0. 945 ). Conclusion Ultrasonography combined with nerve stimulation guidance for continuous femoral nerve block can shorten the procedure time for femoral nerve catheter insertion, and lessen the postoperation subcutaneous congestion at puncture site.%目的 探讨超声联合神经刺激器引导连续股神经阻滞的临床效果.方法 2010年9月对全膝关节置换术后镇痛22例采用超声联合神经刺激器引导连续股神经阻滞(C+S组),23例采用单纯神经刺激器引导连续股神经阻滞(S组).比较2组镇痛效果及穿刺并发症.结果 C+S组操作时间(6.3±3.0)rain,明显短于S组(11.5±7.0)min(t=-3.212,P=0.002).经股神经管推注0.25%罗哌卡因20 ml后15 min麻醉效果差异无显著性(Z=-0.462,P=0.644).术后静态VAS评分(RVAS)、主动功能训练VAS评分(WAS)和持续被动功能训练VAS评分(PVAS)差异无显著性(P>0.05).术后S组5例穿刺部位皮下淤血,C+S组无皮下淤血病例(P=0.049).术后C+S组需要单次推注利多卡因4例,S组为5例,差异无显著性(χ2=0.000,P=1.000).术后72 h哌替啶用量C+S组与S组差异无显著性(Z=-0.069,P=0.945).结论 超声联合神经刺激器引导连续股神经阻滞操作时间明显缩短,同时可以减少穿刺导致的术后皮下淤血.