中国组织工程研究

中国组织工程研究 ›› 2013, Vol. 17 ›› Issue (22): 4005-4012.doi: 10.3969/j.issn.2095-4344.2013.22.003

• 人工假体 artificial prosthesis • 上一篇    下一篇

全膝关节置换后的多模式镇痛

刘冰山，李国军，王晓，张淞，刘洋，张永乐   

  1. 河南大学附属淮河医院骨科，河南省开封市  475000
  • 出版日期:2013-05-28 发布日期:2013-05-28
  • 通讯作者: 李国军，博士，副教授，河南大学附属淮河医院骨科，河南省开封市 475000 lgjhndx@yahoo.com.cn
  • 作者简介:刘冰山★，男，1976年生，河南省开封市人，汉族，主治医师，在读硕士，主要从事创伤骨科及关节外科的研究
  • 基金资助:

    河南省医学科技创新工程资助。

Multimodal analgesia after total knee arthroplasty

Liu Bing-shan, Li Guo-jun, Wang Xiao, Zhang Song, Liu Yang, Zhang Yong-le   

  1. Department of Orthopedics, Huaihe Hospital Affiliated to Henan University, Kaifeng  475000, Henan Province, China
  • Online:2013-05-28 Published:2013-05-28
  • Contact: Li Guo-jun, M.D., Associate professor, Department of Orthopedics, Huaihe Hospital Affiliated to Henan University, Kaifeng 475000, Henan Province, China lgjhndx@yahoo.com.cn
  • About author:Liu Bing-shan★, Studying for master’s degree, Attending physician, Department of Orthopedics, Huaihe Hospital Affiliated to Henan University, Kaifeng 475000, Henan Province, China
  • Supported by:

    Henan Medical Science and Technology Innovation Project*

PDF

559

被引次数

27

摘要：

背景：围全膝关节置换期疼痛处理一直是临床所关注的重点问题，寻找安全有效的镇痛方式，成为关节外科医生的重要任务之一。
目的：比较硬膜外镇痛和股神经阻滞镇痛在患者全膝关节置换后镇痛、康复的效果，探索相关的多模式联合镇痛方案。
方法：随机选取行单侧膝关节置换的患者40例，按照镇痛方案的不同分为硬膜外镇痛组和股神经阻滞镇痛组，每组20例。患者在连续硬膜外麻醉下进行单侧膝关节置换并进行术前宣教和塞来昔布给药。置换后硬膜外镇痛组通过留置导管连接0.2%罗哌卡因、2 mg/L芬太尼止痛泵镇痛；股神经阻滞镇痛组通过股神经阻滞导管间断注射0.2%罗哌卡因镇痛。观察全膝关节置换后患者6，12，24 h和2-7 d每天的疼痛程度，以及2-7 d每天的膝关节活动度。
结果与结论：全膝关节置换后2-7 d，2组患者每天的静息痛和活动痛的目测类比评分均呈下降的趋势，股神经阻滞镇痛组患者的疼痛程度小于硬膜外镇痛组患者。置换后2-7 d，股神经阻滞镇痛组和硬膜外镇痛组患者膝关节活动度都逐渐升高，股神经阻滞镇痛组患者膝关节活动度大于硬膜外镇痛组。结果说明虽然硬膜外镇痛和股神经阻滞镇痛都能缓解全膝关节置换术后疼痛，但股神经阻滞镇痛在全膝关节置换后近期的运动镇痛效果优于硬膜外镇痛，能加快患者关节功能的康复，且多模式联合镇痛方案能有效控制疼痛。

关键词: 骨关节植入物, 人工假体, 全膝关节置换, 硬膜外镇痛, 神经阻滞, 股神经, 多模式镇痛, 罗哌卡因, 康复, 省级基金

Abstract:

BACKGROUND: Perioperative pain management is the focus in total knee arthroplasty. Looking for a safe and effective analgesic way has become one of the important tasks of the surgeons.
OBJECTIVE: To compare the analgesia and rehabilitation effect of the epidural analgesia and the femoral nerve analgesia after total knee arthroplasty, and to explore the relative multimodal analgesia proposal.
METHODS: Forty patients undergoing unilateral total knee arthroplasty were randomly selected, and the patients were divided into two groups according to different analgesia proposals: epidural analgesia group and femoral nerve analgesia group, 20 patients in each group. All patients received unilateral total knee arthroplasty and preoperative missionary and celecoxib administration under epidural analgesia. Patients in the epidural analgesia group were given analgesia with 0.2% ropivacaine and 2 ug/mL fentanyl after the replacement. The patients in the femoral nerve analgesia group were given analgesia with 0.2% popivacaine from the femoral nerve block vessel. The visual analog scores of the patients were observed at 6, 12 and 24 hours and 2-7 days after total knee arthroplasty, and the range of motion was recorded at 2-7 days after total knee arthroplasty.
RESULTS AND CONCLUSION: At 2-7 days after total knee arthroplasty, the visual analog scores of rest/movement pain were decreased in two groups, and the pain degree in the femoral nerve analgesia group was smaller than that in the epidural analgesia group. At 2-7 days after total knee arthroplasty, the range of motion of the patients in two groups was increased gradually, and the range of motion in the femoral nerve analgesia group was larger than in the epidural analgesia group. The results showed that both the epidural analgesia and the femoral nerve analgesia can relieve pain after total knee arthroplasty, but the femoral nerve analgesia can provide better pain relief than epidural analgesia, and it can lead to a quick functional recovery. Multimodal analgesia proposal can effectively control the pain. 

Key words: bone and joint implants, artificial prosthesis, total knee arthroplasty, epidural analgesia, nerve block, femoral nerve, multimodal analgesia, ropivacaine, rehabilitation, provincial grants-supported paper 

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