Objective To evaluate the efficacy of ultrasound-guided continuous saphenous nerve block for postoperative analgesia after total knee prosthesis under general anesthesia in elderly patients.Methods Ninety patients aged 61 ～ 79 years with ASA Ⅰ ～ Ⅲ scheduled to undergo unilateral total knee prosthesis under general anesthesia were randomly divided into three groups with 30 cases each.In group Ⅰ,sufentanil was used for patient controlled intravenous analgesia (PCIA),while in group F and group S,continuous femoral nerve block or saphenous nerve block were used respectively for postoperative analgesia.Visual analogue scale (VAS) pain scores in rest and movement,quadriceps strength levels,comfort levels,the case of analgesic drug addition and occurrence rate of side-effects were recorded at the 2h(T1),6h(T2),12h(T3),24h(T4) and 48h(T5) after surgery.Results The VAS pain scores in rest of the groups F and S were significantly lower than that of the group Ⅰ at time points of T1,T2 and T3 (P＜0.05),while there was no significant difference at T4～ T5 (P ＞0.05).The VAS pain scores in motion of group F and S were significantly lower than that of group Ⅰ at time points T1 ～ T5 (P＜0.05).The quadriceps strength levels in group Ⅰ and group S had no significant difference at T1 ～ T5,while the quadriceps strength levels in group F were significantly lower than those in group Ⅰ and S (P＜0.05).The comfort scores of group S and F were significantly higher than that of group Ⅰ at T1 ～ T5(P＜0.05).The cases of analgesic drug addition in the group of Ⅰ (21,70％) were more than those of the group F (2,6.67％) and S (4,13.33％) (P＜0.05).The rate of nausea,vomiting and drowsiness in group Ⅰ was higher than that in group F and group S (P＜0.05).The rate of other adverse effect had no significant difference in the three groups.Conclusion Continuous saphenous nerve block and continuous femoral nerve block have similar efficacy for postoperative analgesia and low incidence of side-effects in the patients undergoing total knee prosthesis,but the quadriceps muscle strength is less affected in saphenous nerve block.%目的 评估超声引导连续隐神经阻滞在老年患者全膝关节置换术后镇痛的临床效果.方法 将全麻下全膝关节置换手术患者90例按随机数字表法分为3组,分别于术后48h的舒芬太尼静脉注射(Ⅰ组)、连续股神经阻滞(F组)和连续隐神经阻滞(S组)自控镇痛治疗,每组30例.记录术后2h(T1)、6h(T2)、12h(T3)、24h(T4)、48h(T5)患者下肢静止情况下VAS(RVAS)评分、被动屈膝VAS(MVAS)评分、股四头肌肌力、舒适度评分、镇痛药追加情况和不良反应.结果 术后T1～T3RVAS评分F组和S组低于Ⅰ组(均P＜0.05),其他时点RVAS评分差异无统计学意义(P＞0.05);T1～ T5时点F组和S组MVAS评分均明显低于Ⅰ组(均P＜0.05);T1～Ts时点Ⅰ组和S组股四头肌肌力差异无统计学意义(P＞0.05),但明显高于F组(P＜0.05).T1～ T5时点舒适度评分S组和F组高于Ⅰ组(P＜0.05).Ⅰ组术后追加镇痛药物者比例明显高于F组和S组(P＜0.05),Ⅰ组恶心、呕吐和嗜睡发生率高于F组和S组(P＜0.05),其他不良反应差异无统计学意义(P＞0.05).结论 连续隐神经阻滞在老年全膝关节置换术后与连续股神经阻滞镇痛效果相当,且对股四头肌肌力影响更少.
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