收肌管阻滞与股神经阻滞用于半月板切除术后镇痛效果的比较

摘要

Objective To compare the analgesic efficacy of ultrasound-guided continuously postoperative adductor canal block (ACB) and femoral nerve block (FNB) after arthroscopic menisectony.Methods Forty patients for elective menisectomy were assigned to two groups randomly,ACB group and FNB group with 20 cases each.The adductor canal block and femoral nerve block after the continuous epidural anesthesia.0.5％ ropivacaine 20 ml was given.visual analogue scales(VAS) at rest and movement in postoperative 2,6,12,24 h,quadriceps muscle strength,side effects and additional analgesic dose were recorded.Results There was no significant difference in the VAS between the two groups.The quadriceps muscle strength grading of group FNB and group ACB were 1 (1-2) and 3(3-4),2(1-2) and 4(3-4),3(3-4) and 4(4-4),respectively(P＜0.01).There was no significant difference in the quadriceps muscle strength in postoperative 24 h.There was no headache,nausea and vomiting,urinary retention and other adverse reactions observed in both groups.Conclusions The efficacy of analgesia was no difference postoperatively.ACB preserved quadriceps muscle strength better than FNB in postoperative 2,6,12 h.%目的 比较收肌管阻滞(adductor canal block group,ACB)与股神经阻滞(femoral nerve block group,FNB)用于半月板切除术后镇痛效果. 方法 择期行半月板切除手术患者40例,完全随机分为两组(每组20例):ACB和FNB组.两组在连续硬膜外麻醉下完成手术.麻醉前在超声引导下行ACB和FNB,用药为0.5％罗哌卡因20 ml.记录术后2、6、12、24 h静息下、主动运动(直腿抬高)和被动运动(被动膝关节屈曲60度)时视觉模拟评分法(visual analogue scales,VAS)评分以及股四头肌肌力分级、用药副作用和使用镇痛药的情况. 结果 两组患者术后均达到良好镇痛,术后24 h内两组VAS评分差异无统计学意义.术后2、6、12h内股四头肌肌力分级FNB组和ACB组分别为1(1～2)和3(3～4)、2(1～2)和4(3～4)、3(3～4)和4(4～4)(P＜0.01),术后24 h两组股四头肌肌力分级差异无统计学意义.两组均无明显的副作用. 结论 为人FNB和ACB都可以提供良好的术后早期镇痛,但是ACB患者的股四头肌肌力在术后早期明显高于FNB患者,有利于早期功能锻炼.