甲磺酸罗哌卡因辅以酒石酸布托啡诺连续隐神经置管阻滞在全膝关节置换术后镇痛的临床观察

摘要

目的 观察甲磺酸罗哌卡因辅以酒石酸布托啡诺应用于连续隐神经置管阻滞(saphenous nerve block,SNB)在全膝关节置换(total knee arthroplasty,TKA)术后镇痛的效果及不良反应.方法 选择我院TKA患者120例,术后连续SNB置管阻滞镇痛,剂量5mL/h总量350mL,随机分为三组:A组0.2%甲磺酸罗哌卡因辅以酒石酸布托啡诺20μg/mL,B组0.2%甲磺酸罗哌卡因辅以芬太尼2μg/mL,C组0.25%甲磺酸罗哌卡因,记录三组患者12h、24h、72h的视觉模拟评分(VAS评分)、辅助功能锻炼时视觉模拟评分、患肢麻木感、恶心呕吐等不良反应.结果 三组各时点静息VAS评分差异无统计学意义;三组分别于12h、24h、72h功能锻炼的VAS评分,A组(4.2±1.1)、(4.4±1.3)、(4.3±1.2)和B组(4.1±1.3)、(4.5±1.2)、(4.4±1.2)显著低于C组(5.1±1.3)、(5.4±1.5)、(5.6±1.0)(P<0.05),且A组和B组差异无统计学意义;C组患肢麻木感发生率(10例)明显高于A组(2例)和B组(2例)(P<0.05),且A组和B组差异无统计学意义;B组PONV评分(2.8±0.9)高于A组(2.0±0.8)和C组(2.0±0.7)(P<0.05),且A组和C组差异无统计学意义;A组首次下地活动时间(24.5±12.1h)和B组(24.7±11.6h)显著短于C组(33.0±11.1h)(P<0.05),且A组和B组差异无统计学意义.结论 0.2%罗哌卡因辅以酒石酸布托菲诺应用于连续SNB可为TKA提供完善的术后镇痛,延长甲磺酸罗哌卡因阻滞时间,缩短患者首次下地活动时间,不良反应较少.%Objective To Observe the effect and adverse reactions of ropivacaine mesylate and butorphanol tartrate in the application of continuous saphenous nerve block(SNB)for analgesia after total knee arthroplasty(TKA). Methods 120 patients with TKA in our hospital were selected to receive continuous SNB,a total dose of 350 ml in 5 ml/h,after surgery and were random-ly divided into three groups:group A received 0. 2% ropivacaine mesylate supplemented with butorphanol tartrate 20μg/ml,group B received 0. 2% ropivacaine mesylate supplemented with fentanyl 2μg/ml,and group C received 0. 25% ropivacaine mesylate. Visual analog scale scores(VAS scores)at 12h,24h,and 72h,visual analogue scores during assistive exercise,numbness of affected limbs,and nausea and vomiting were recorded the in three groups of patients. Results There was no significant difference in rest-ing VAS scores at all time points among the three groups;The VAS scores of functional exercise at 12h,24h,and 72h in Group A (4. 2 ±1. 1),(4. 4 ±1. 3),(4. 3 ±1. 2)and Group B(4. 1 ±1. 3),(4. 5 ±1. 2),(4. 4 ±1. 2)were significantly lower than group C(5. 1 ± 1. 3),(5. 4 ± 1. 5),(5. 6 ± 1. 0)(P<0. 05),and there was no significant difference between group A and group B. The incidence of numbness in the affected limbs in group C(10 cases)was significantly higher than that of group A(2 cases)and group B(2 cases)(P <0.05),and the difference between group A and group B was not significant. No statistical significance; The PONV score of group B(2.8 ±0.9)was higher than that of group A(2.0 ±0.8)and group C(2.0 ±0.7)(P<0.05),and there was no significant difference between group A and group C;The leaving bed time of group A(24. 5 ± 12. 1h)and group B(24. 7 ±11. 6h)was significantly shorter than that of group C(33. 0 ± 11. 1h)(P<0. 05),and there was no significant difference between group A and group B. Conclusion The application of 0. 2% ropivacaine supplemented with Butoxifene tartrate to continuous SNB can provide complete postoperative analgesia for TKA,prolong the time of ropivacaine mesylate block,shorten the leaving bed time, and reduce adverse reactions.