中国组织工程研究

中国组织工程研究 ›› 2026, Vol. 30 ›› Issue (21): 5421-5428.doi: 10.12307/2026.775

• 人工假体 artificial prosthesis • 上一篇    下一篇

单次脂质体布比卡因与持续罗哌卡因用于全膝关节置换后收肌管阻滞镇痛

刘成龙1，2，韦善文3，李  迪4，邹明明5，马艳霞3，6   

  1. 1高邮市人民医院麻醉科，江苏省高邮市  225600；2江苏医药职业学院高邮临床学院，江苏省高邮市  225600；苏州大学附属第一医院，3骨科，4神经外科，江苏省苏州市  215000；5解放军总医院第一医学中心神经外科医学部，北京市  100853；6苏州大学骨科研究所，江苏省苏州市  215006
  • 接受日期:2025-08-09 出版日期:2026-07-28 发布日期:2026-03-04
  • 通讯作者: 马艳霞，硕士，实验师，苏州大学附属第一医院骨科，江苏省苏州市 215000；苏州大学骨科研究所，江苏省苏州市 215000 邹明明，博士，主治医师，解放军总医院第一医学中心神经外科医学部，北京市 100853
  • 作者简介:刘成龙，2025年苏州大学毕业，博士，主任医师，主要从事临床麻醉及术后镇痛相关研究。 韦善文，硕士，主管技师，主要从事临床神经电生理的相关研究
  • 基金资助:
    国家自然科学基金青年项目(81801238)，项目负责人：李迪；江苏医药职业学院校外教学基地科研发展专项课题，项目负责人：刘成龙

Liposomal bupivacaine versus continuous ropivacaine infusion in adductor canal block for total knee arthroplasty

Liu Chenglong1, 2, Wei Shanwen3, Li Di4, Zou Mingming5, Ma Yanxia3, 6   

  1. 1Department of Anesthesiology, Gaoyou People’s Hospital, Gaoyou 225600, Jiangsu Province, China; 2Gaoyou Clinical College, Jiangsu Medicine College, Gaoyou 225600, Jiangsu Province, China; 3Department of Orthopedics, 4Department of Neurosurgery, First Affiliated Hospital of Soochow University, Suzhou 215000, Jiangsu Province, China; 5Department of Neurosurgery, First Medical Center of Chinese PLA General Hospital, Beijing 100853, China; 6Institute of Orthopedics, Soochow University, Suzhou 215006, Jiangsu Province, China
  • Accepted:2025-08-09 Online:2026-07-28 Published:2026-03-04
  • Contact: Ma Yanxia, MS, Experimentalist, Department of Orthopedics, First Affiliated Hospital of Soochow University, Suzhou 215000, Jiangsu Province, China; Institute of Orthopedics, Soochow University, Suzhou 215006, Jiangsu Province, China Co-corresponding author: Zou Mingming, PhD, Attending physician, Department of Neurosurgery, First Medical Center of Chinese PLA General Hospital, Beijing 100853, China
  • About author:Liu Chenglong, PhD, Chief physician, Department of Anesthesiology, Gaoyou People’s Hospital, Gaoyou 225600, Jiangsu Province, China; Gaoyou Clinical College, Jiangsu Medicine College, Gaoyou 225600, Jiangsu Province, China Wei Shanwen, MS, Technician-in-charge, Department of Orthopedics, First Affiliated Hospital of Soochow University, Suzhou 215000, Jiangsu Province, China Liu Chenglong and Wei Shanwen contributed equally to this article.
  • Supported by:
    National Natural Science Foundation of China, No. 81801238 (to LD); Jiangsu Medical Vocational College Off-campus Teaching Base Scientific Research Development Special Project (to LCL)

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摘要：

文题释义：

脂质体布比卡因：是一种新型的长效局部麻醉药，采用多囊脂质体包裹技术，使布比卡因在注射部位缓慢释放，维持镇痛效果长达72 h，远超传统布比卡因的4-8 h。它主要用于术后局部浸润镇痛(如疝修补术、关节置换术、乳腺手术等)，可显著减少术后阿片类药物的使用量，降低恶心、便秘等阿片相关不良作用。脂质体布比卡因的优势在于精准的局部缓释作用，减少全身吸收，安全性较高。目前研究仍在探索其在周围神经阻滞和慢性疼痛治疗中的潜在应用。
收肌管阻滞：是一种针对膝关节周围疼痛的超声引导下区域麻醉技术，主要通过阻滞收肌管内的隐神经提供膝关节镇痛，同时保留股四头肌肌力，利于术后早期活动。该技术常用于全膝关节置换、前交叉韧带重建等术后镇痛，可有效减轻疼痛并减少阿片类药物用量，尤其适合强调快速康复的病例。相较于传统股神经阻滞，收肌管阻滞能更好地保留下肢运动功能，降低跌倒风险。操作时需在超声定位下于股动脉旁收肌管内注射局部麻醉药，并发症较少，安全性较高。

摘要
背景：全膝关节置换后有效镇痛对康复至关重要，收肌管阻滞是常用方法。传统单次注射局麻药镇痛时效有限，而持续导管输注操作复杂、成本较高。
目的：比较单次注射脂质体布比卡因与持续导管输注盐酸罗哌卡因用于全膝关节置换后收肌管阻滞镇痛效果的有效性和安全性。
方法：选择2024年3月至2025年2月在高邮市人民医院进行初次单侧膝关节置换的患者80例，随机分为脂质体布比卡因组和持续导管输注组。脂质体布比卡因组患者术后接受单次脂质体布比卡因收肌管阻滞治疗，注射药物为133 mg(10 mL)的脂质体布比卡因混合0.75%盐酸罗哌卡因5 mL；持续导管输注组患者接受收肌管持续导管输注治疗，收肌管隐神经附近置入硬膜外导管，连接0.25%盐酸罗哌卡因镇痛泵，负荷量为0.25%盐酸罗哌卡因10 mL，输注速度为6 mL/h。通过比较术后两组患者不同时间点疼痛评分、术后无痛时间、吗啡补救治疗量、术后行走距离来评估镇痛有效性；观察治疗并发症评估镇痛安全性。同时，比较两组患者镇痛操作所需时间、费用、患者满意度以及住院时间等指标。 
结果与结论：①在术后6，12，24，48，72 h时间点，脂质体布比卡因组和持续导管输注组患者的静息和运动疼痛评分无显著性差异(P > 0.05)；脂质体布比卡因组术后无痛时间为19 h，持续导管输注组为22 h，差异无显著性意义(P > 0.05)；②术后72 h，脂质体布比卡因组吗啡补救镇痛量为78.6吗啡当量剂量，而持续导管输注组为80.5吗啡当量剂量，差异无显著性意义(P > 0.05)；③在镇痛操作时间上，脂质体布比卡因组平均耗时(6.1±1.4) min，而持续导管输注组平均耗时(20.3±1.2) min，差异有显著性意义(P < 0.05)；④在患者满意度、住院时间和行走能力上，两组无显著性差异(P > 0.05)；⑤持续导管输注组术后6 h有1例股四头肌麻痹，患者自行恢复且无其他并发症；另外每位脂质体布比卡因组患者在镇痛治疗上可节省132元人民币；⑥提示在全膝关节置换术后72 h内，单次脂质体布比卡因与持续导管输注罗哌卡因在镇痛评分、术后无痛时间以及吗啡补救治疗量方面无差异，在平均住院时间、患者满意度和行走能力上无差异，但单次脂质体布比卡因收肌管阻滞治疗操作更加方便，节约了时间和成本。



中国组织工程研究杂志出版内容重点：人工关节；骨植入物；脊柱；骨折；内固定；数字化骨科；组织工程

关键词: 脂质体布比卡因, 持续输注, 全膝关节置换, 收肌管, 术后镇痛

Abstract: BACKGROUND: Effective analgesia after total knee arthroplasty is crucial for rehabilitation, with adductor canal block being a commonly used method. Traditional single-injection local anesthetics provides limited analgesic duration, and continuous catheter infusion exhibits complexity and high cost.  
OBJECTIVE: To compare the efficacy and safety of a single injection of liposomal bupivacaine versus continuous catheter infusion of ropivacaine hydrochloride for adductor canal block analgesia after total knee arthroplasty.  
METHODS: Eighty patients undergoing primary unilateral total knee arthroplasty at Gaoyou People’s Hospital from March 2024 to February 2025 were randomly assigned to two groups: the liposomal bupivacaine group and the continuous infusion group. The liposomal bupivacaine group received a single adductor canal block injection of 133 mg (10 mL) liposomal bupivacaine mixed with 5 mL of 0.75% ropivacaine hydrochloride postoperatively. The continuous infusion group received an adductor canal block catheter placed near the saphenous nerve, connected to an analgesic pump delivering 0.25% ropivacaine hydrochloride (loading dose: 10 mL; infusion rate: 6 mL/h). Analgesic efficacy was assessed by comparing pain scores at various time points postoperatively, postoperative analgesia-free duration, morphine rescue consumption, and postoperative walking distance in both groups. Safety was evaluated by monitoring complications. Additionally, procedural time, cost, patient satisfaction, and hospital stay were compared between the two groups.  
RESULTS AND CONCLUSION: (1) Pain scores at rest and during movement showed no significant differences between liposomal bupivacaine group and continuous infusion group at 6, 12, 24, 48, and 72 hours postoperatively (P > 0.05). The postoperative analgesia-free duration was 19 hours in the liposomal bupivacaine group and 22 hours in the continuous infusion group (P > 0.05). (2) Within 72 hours postoperatively, the liposomal bupivacaine group required an average of 78.6 morphine rescue treatments, while the continuous infusion group required 80.5, without significant differences (P > 0.05). (3) Procedural time was significantly shorter in the liposomal bupivacaine group (6.1±1.4 min) than in the continuous infusion group (20.3±1.2 min, P < 0.05). (4) No differences were observed in patient satisfaction, hospital stay, or walking ability (P > 0.05). (5) One case of quadriceps paralysis occurred in the continuous infusion group at 6 hours postoperatively but resolved spontaneously without further complications. Each patient in the liposomal bupivacaine group saved 132 RMB in analgesia-related costs. (6) It is concluded that within 72 hours after total knee arthroplasty, single-injection liposomal bupivacaine provided comparable analgesia to continuous ropivacaine infusion in terms of pain scores, postoperative analgesia-free duration, and morphine rescue requirements. Hospital stay, patient satisfaction, and functional recovery were similar. However, single-injection liposomal bupivacaine adductor canal block is more convenient, saves time, and reduces costs. 


Key words: liposomal bupivacaine, continuous infusion, total knee arthroplasty, adductor canal block, postoperative analgesia

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