双膝置换术中鸡尾酒与股神经阻滞镇痛的随机对照研究

A Randomized Controlled Trial of Cocktail and Femoral Nerve Block Analgesia in Double Knee Arthroplasty

摘要: 目的：对比双侧全膝关节置换(total knee arthroplasty, TKA)术中运用关节腔周围注射鸡尾酒与股神经阻滞的镇痛效果。方法：选取2015年1月至2017年10月，我院收治的20例行双侧TKA的患者(40膝)，其中男6例，女14例；年龄50~78岁，平均63岁。对双膝随机进行镇痛，一侧使用膝关节腔鸡尾酒注射，一侧使用股神经阻滞，术后常规镇痛，肌注帕瑞昔布钠(40 mg，2次/天)，2天后改为口服塞来昔布(0.2 g，2次/天)，记录术后72 h内疼痛视觉模拟评分(visual analogue scale, VAS) (1~10分)、手术时间、出血量、出院时膝关节活动度、住院时间等指标，并运用t检验及χ2检验统计分析。结果：20例40膝例均获6周随访，术后24 h VAS评分：试验组(3.0 ± 1.2)分，小于对照组的(4.4 ± 1.5)分，差异有统计学意义(P < 0.05)，关节活动度术后1周实验组(100˚ ± 8˚)，对照组(90˚ ± 10˚)，差异有统计学意义(P < 0.05)；而手术时间、出血量、术后6周关节活动度差异无统计学意义。结论：TKA应用关节腔周围注射鸡尾酒术后镇痛效果更佳，不显著延长手术时间，术后早期关节活动度更大。

Abstract: Objective: To compare the analgesic effect of intra-articular injection of cocktail and femoral nerve block on total knee arthroplasty (TKA). Methods: From January 2015 to October 2017, 20 patients with bilateral TKA (40 knees) were selected from our hospital, including 6 males and 14 females, aged 50~78 years, with an average age of 63 years. Randomized analgesia on both knees, one side of the knee cavity cocktail injection, femoral nerve block on one side, routine postoperative analgesia, intramuscular parecoxib sodium (40 mg twice daily), and oral celecoxib after 2 days (0.2 g, 2 times/day), record visual analogue scale (VAS) (1~10 points), operation time, and output within 72 hours after operation were used. Blood volume, knee joint mobility, length of hospital stay, and other indicators were measured using the t-test and χ2 test. Results: 20 cases of 40 knees cases were followed up for 6 weeks. The VAS score after 24 h of treatment group was (3 + 1.2) points, less than control group (4.4 + 1.5), which had statistically significant difference (P < 0.05); the joint activity of experimental group 1 week after operation was in the range of (100˚ + 8˚) and control group of (90˚ + 10˚), whose difference was statistically significant (P < 0.05); there was no statistical significance between operation time, bleeding volume, and joint activity range at postoperative 6 weeks. Conclusion: TKA has better analgesic effect after the operation of the intraarticular injection of cocktail, and it does not prolong the operation time, and the early joint activity is greater after the operation.