摘要
目的评价收肌管联合腘动脉与膝关节后囊间隙(IPACK)阻滞用于全膝关节置换术后多模式镇痛的效果。方法脊椎-硬膜外联合麻醉下行择期单侧全膝关节置换术的患者60例,性别不限,年龄55~78岁,ASA分级Ⅰ-Ⅲ级,采用电脑随机数法将患者分为2组(n=30):收肌管联合IPACK阻滞组(A+I组)和收肌管阻滞组(A组)。均采用预防性多模式镇痛:术前疼痛管理宣教;麻醉诱导前静脉注射氟比洛芬酯50 mg,术后口服塞来昔布200 mg,2次/d,控制炎性痛;超声引导下A+I组行收肌管联合IPACK阻滞,A组行收肌管阻滞,抑制切口痛;静脉注射纳布啡0.08 mg/kg抑制爆发痛。维持术后静态和动态数字评分(NRS静态和NRS动态)<5分。计算术后48 h内NRS静态和NRS动态的曲线下面积(AUCNRS静态和AUCNRS动态)。记录纳布啡补救镇痛情况;记录术后1和2 d下床最多活动步数和最大膝关节活动度;记录神经阻滞相关不良事件以及术后康复训练相关不良事件的发生情况和术后住院时间。结果与A组比较,A+I组AUCNRS静态和AUCNRS动态降低,纳布啡用量减少,下床最多活动步数和最大膝关节活动度升高(P<0.05),纳布啡使用率、住院时间差异无统计学意义(P>0.05)。2组均未见阻滞相关不良事件以及术后康复训练相关不良事件发生。结论收肌管联合IPACK阻滞用于全膝关节置换术后多模式镇痛可提供较为完善的镇痛效果,有助于患者恢复。
Objective To evaluate the efficacy of adductor canal combined with interspace between the popliteal artery and the capsule of the posterior knee(IPACK)block for multimodal analgesia after total knee arthroplasty(TKA).Methods Sixty American Society of Anesthesiologists physical statusⅠ-Ⅲpatients of both sexes,aged 55-78 yr,scheduled for elective unilateral TKA under combined spinal-epidural anesthesia,were assigned into 2 groups(n=30 each)using a computer random number method:adductor canal combined with IPACK block group(group A+I)and adductor canal block group(group A).Preventive multimodal analgesia was applied as follows:preoperative pain management education was performed;flurbiprofen 50 mg was intravenously injected before induction of anesthesia,and celecoxib 200 mg was taken orally after surgery,twice a day,to control inflammatory pain;ultrasound-guided adductor canal combined with IPACK block was performed in group A+I,and ultrasound-guided adductor canal block was performed in group A to inhibit incisional pain;nalbuphine 0.08 mg/kg was intravenously injected to inhibit breakthrough pain.Postoperative numeric rating scale(NRS)scores at rest(NRSr)and on movement(NRSm)were maintained<5 within 48 h after surgery.The area under the curve(AUC)of NRSr and NRSm(AUCNRSr and AUCNRSm)were calculated within 48 h after surgery.The requirement for nalbuphine as rescue analgesic was recorded.The maximum number of ambulatory steps and maximum range of knee motion were recorded on 1 and 2 days after surgery.The development of nerve block-and postoperative rehabilitation training-related adverse events and postoperative length of hospitalization were also recorded.Results Compared with group A,AUCNRSr and AUCNRSm were significantly decreased,the consumption of nalbuphine was reduced,and the maximum number of ambulatory steps and maximum range of knee motion were increased(P<0.05),and no significant change was found in the requirement for nalbuphine or length of hospitalization in group A+I(P>0.05).No nerve block-and postoperative rehabilitation training-related adverse events were found in neither group.Conclusion Adductor canal combined with IPACK block can provide a relatively perfect efficacy when used for multimodal analgesia after TKA and is helpful for patient′s recovery.
作者
李敏
陈鹭
吴黄辉
杨菲
陈国忠
吴晓智
Li Min;Chen Lu;Wu Huanghui;Yang Fei;Chen Guozhong;Wu Xiaozhi(Department of Anesthesiology and Perioperative Medicine,900 Hospital of the Joint Logistics Team of the PLA,Fuzhou 350025,China;Department of Anesthesiology,The First Affiliated Hospital of Fujian Medical University,Fuzhou 350005,China)
出处
《中华麻醉学杂志》
CAS
CSCD
北大核心
2019年第5期574-577,共4页
Chinese Journal of Anesthesiology
基金
国家自然科学基金(81701091)
福建省自然科学基金(2016J01476、2016J01588)
福建医科大学苗圃基金(2015MP028)
