超声引导布比卡因脂质体收肌管阻滞用于老年患者全膝关节置换术镇痛的效果
Effect of ultrasound-guided adductor canal block with bupivacaine liposome on analgesia in elderly patients undergoing total knee arthroplasty
樊超 1周俊辉 2孙全鹏 3张永杰 4全立新 1梅伟 5高俊伟 1白伟杰 1薄文杰 1徐璐丹1
作者信息
- 1. 郑州市骨科医院麻醉科,郑州 450052
- 2. 河南省胸科医院&郑州大学附属胸科医院麻醉科,郑州 450003
- 3. 郑州大学第一附属医院麻醉与围术期医学科,郑州 450044
- 4. 河南科技大学第一附属医院麻醉科,洛阳 471000
- 5. 郑州市骨科医院骨科,郑州 450052
- 折叠
摘要
目的 评价超声引导布比卡因脂质体收肌管阻滞用于老年患者全膝关节置换术后镇痛的效果.方法 本研究为前瞻性研究.选择2023年4月至2024年1月郑州市骨科医院择期蛛网膜下腔麻醉下行单侧全膝关节置换术患者60例,性别不限,年龄65～83岁,体质量50～80 kg,ASA分级Ⅱ或Ⅲ级,采用随机数字表法分为2组(n=30):布比卡因脂质体组(LB组)和罗哌卡因组(R组).于蛛网膜下腔麻醉前30 min,在超声引导下行收肌管神经阻滞,LB组注射布比卡因脂质体稀释液20 ml(133 mg),R组注射0.5％罗哌卡因20 ml.术后行PCIA,VAS评分≥3分时,采用曲马多进行补救镇痛.分别于术后8、12、24、48和72 h时记录静态和动态VAS评分.记录术后首次按压镇痛泵时间和术后72 h内补救镇痛情况;分别于术前1 d和术后12、24、48、72 h时测定股四头肌肌力;分别于术前1 d和术后24、48、72 h时测定膝关节活动度.术后72 h时记录患者镇痛满意度评分;记录术后72 h内不良反应发生情况.结果 与R组比较,LB组术后12、24、48和72 h时静态和动态VAS评分降低,首次按压镇痛泵时间延长,术后补救镇痛率降低,镇痛满意度评分升高,膝关节活动度增加(P＜0.05),股四头肌肌力和不良反应发生率差异无统计学意义(P＞0.05).结论 超声引导布比卡因脂质体收肌管阻滞用于老年患者全膝关节置换术的镇痛效果优于罗哌卡因.
Abstract
Objective To evaluate the effect of ultrasound-guided adductor canal block with bupiv-acaine liposome on analgesia in elderly patients undergoing total knee arthroplasty.Methods This was a prospective study.Sixty American Society of Anesthesiologists Physical Status classification Ⅱ or Ⅲ pa-tients,regardless of gender,aged 65-83 yr,weighing 50-80 kg,scheduled for elective unilateral total knee arthroplasty under subarachnoid anesthesia from April 2023 to January 2024 in Zhengzhou Orthopaedic Hos-pital,were divided into 2 groups(n=30 each)using a random number table method:bupivacaine liposome group(LB group)and ropivacaine group(R group).Ultrasound-guided adductor canal block was performed at 30 min before subarachnoid anesthesia,bupivacaine liposome diluent 20 ml(133 mg)was injected in LB group,and 0.5％ropivacaine 20 ml was injected in R group.Patient-controlled intravenous analgesia was performed after operation,and tramadol was used for rescue analgesia when the visual analogue scale(VAS)score ≥3.VAS scores at rest and during activity were recorded at 8,12,24,48 and 72 h after sur-gery.The time to the first pressing analgesia pump and rescue analgesia were recorded within 72 h after sur-gery.The quadriceps muscle strength was measured at 1 day before surgery and 12,24,48 and 72 h after surgery.The knee joint range of motion was assessed at 1 day before surgery and 24,48 and 72 h after sur-gery.Patient's satisfaction with analgesia was recorded at 72 h after surgery.The adverse reactions within 72 h after surgery were also recorded.Results Compared with R group,VAS scores at rest and during activity were significantly decreased at 12,24,48 and 72 h after surgery,the time to the first pressing analgesia pump was prolonged,the rate of rescue analgesia after surgery was decreased,the score for the patient's sat-isfaction with analgesia was increased,the knee joint range of motion was increased(P＜0.05),and no sig-nificant change was found in the quadriceps muscle strength and incidence of adverse reactions in LB group(P＞0.05).Conclusions Ultrasound-guided adductor canal block with bupivacaine liposome provides bet-ter analgesia than ropivacaine in elderly patients undergoing total knee arthroplasty.
关键词
布比卡因/脂质体/收肌管/神经传导阻滞/镇痛/关节成形术,置换,膝Key words
Bupivacaine/Liposomes/Adductor canal/Nerve block/Analgesia/Arthro-plasty,replacement,knee引用本文复制引用
基金项目
河南省科技攻关项目(LHGJ20200758)
中国初级卫生保健基金会"爱医研,爱无限"临床科研公益项目(YYWX202410004ZZ)
出版年
2024
NETL
NSTL
万方数据