连续腰丛联合坐骨神经阻滞对全膝关节置换术后疼痛及早期疗效的影响

摘要

目的:评价连续腰丛联合坐骨神经阻滞在全膝关节置换术后镇痛及早期临床疗效的作用.方法:2009年10月至2011年6月,60例接受全膝关节置换术的骨性关节炎患者随机分为2组,每组30例,分别采用连续腰丛联合坐骨神经阻滞镇痛(continuous psoas plexus and sciatic nerve block analgesia,CPSA)、静脉自控镇痛(patient-controlled intravenous analgesia,PCIA);比较两组患者术前及术后4、8、12、24、36、48、72 h不同时间点静息时VAS评分(rest visual analog scale,RVAS)和被动活动时VAS评分(passive VAS,PVAS),吗啡类镇痛药物追加使用量及不良反应发生率,术前及术后72 h内下肢肌力Bromage评分,术后0、2和12周膝关节功能美国特种外科医院评分(hospital for special surgery,HSS)以及并发症.结果:与PCIA组相比,CPSA组术后12h,24 h,36h的RVAS评分和24 h,36 h,48 h的PVAS评分降低(P＜0.05),术后吗啡类镇痛药使用量减少(P＜0.05),术后镇痛药物所致不良反应率减少(P＜0.05),患侧下肢肌力Bromage评分无差异(P＞0.05),不增加术后相关并发症.随访12周,两组患者TKA术后HSS评分均较术前(0w)有显著性差异(P＜0.05),两组术后早期HSS评分差异无统计学意义(P＞0.05).结论:连续腰丛联合坐骨神经阻滞镇痛能显著缓解患者术后疼痛,且不良反应少,有利于患者进行早期功能康复,但是对全膝关节置换术后患者的早期临床疗效无明显影响.%Objective: To evaluate the analgesic efficacy and early functional outcome of continuous psoas plexus and sciatic nerve block on total knee arthroplasty (TKA). Methods: 60 patients who underwent TKA were randomly and evenly divided into two groups: continuous psoas plexus and sciatic nerve block analgesia (CPSA) group and patient-controlled intravenous analgesia (PCIA) group. The CPSA group received a combination of continuous psoas plexus and sciatic nerve block. The PCIA group received a patient-controlled intravenous analgesia. Visual analog scale (VAS), morphine requirements, early knee function and side effects were recorded. Results: After TKA, the RVAS scores of 12 h, 24 h, 36 h and the PVAS scores of 24 h, 36 h, 48 h in the CPSA group were significant lower than that in PCIA group (P < 0.05). The morphine requirement and associated side effects in CPSA group were reduced significantly than that in PCIA group (P < 0.05). The knee function of both groups were improved significantly after TKA. There was no difference on the early functional recovery between CPSA group and PCIA group at 2 weeks and 12 weeks after TKA (P > 0.05). Conclusion: Combination of continuous psoas plexus and sciatic nerve block provides reliable analgesia, reduces morphine requirement and side effects after TKA.