全膝置换两个筋膜间隙联合阻滞的镇痛效果△

Analgesic effect of combined two fascial spaces block in total knee arthroplasty

摘要:

[目的]探讨收肌管阻滞（adductor canal block, ACB）联合腘动脉与膝关节后囊间隙（interspace between the popliteal artery and capsule of the knee, IPACK）阻滞在全膝关节置换术（total knee arthroplasty, TKA）的镇痛效果。[方法]2020 年 2 月— 2022 年 6 月 84 例终末期膝骨性关节炎患者在静脉全麻下进行初次单侧 TKA 术，依据术前医患沟通结果，42 例采用 ACB、 PACK 联合 I 阻滞（联合组），另外 42 例采用单纯 ACB 阻滞（ACB 组），比较两组围手术期临床与镇痛相关资料。[结果]两组手术时间、总不良反应、术中失血量差异无统计学意义 （P＞0.05），联合组术后恢复下地行走显著早于 ACB 组 [(18.5±4.3) h vs (30.4±6.7) h, P＜0.001]，联合组术后 8 h [(69.3±7.3)° vs (64.8±6.9)°, P=0.005]、术后 24 h [(70.1±6.3)° vs (65.2±6.7)°, P=0.001] 膝 ROM 显著大于 ACB 组。术后 2~24 h 两组的 VAS 评分均有所上升，但联合组术后各时间点均显著低于 ACB 组（P＜0.05），联合组首次补救镇痛时间 [(6.3±1.8) h vs (10.4±2.3) h, P＜0.001]、镇痛泵按压次数 [(3.0±0.5) 次 vs (5.7±0.7) 次, P＜0.001]、使用血管活性药物次数 [(1.0±0.2) 次 vs (1.7±0.4) 次, P＜0.001]、额外镇痛药使用次数 [(1.4±0.4) 次 vs (1.9±0.6) 次, P＜0.001] 均显著低于 ACB 组。[结论] ACB 联合 IPACK 阻滞能够降低 TKA 术后疼痛症状，提升膝关节活动度，缩短恢复下床时间。

Abstract:

[Objective] To explore the analgesic effect of adductor canal block (ACB) combined with the interspace between the popliteal artery and capsule of the knee (IPACK) block in total knee arthroplasty (TKA). [Methods] From February 2020 to June 2022, 84 patients with end-stage knee osteoarthritis underwent primary unilateral TKA under intravenous general anesthesia. According to preoperative doctor-patient communication, 42 patients received ACB combined with IPACK blocks (combined group), while other 42 patients received ACB block alone (ACB group). The perioperative clinical and analgesic data were compared between the two groups. [Results] There were no significant differences in operation time, total adverse reactions，and intraoperative blood loss between the two groups (P＜0.05), whereas the combined group resumed postoperative walking significantly earlier than the ACB group [(18.5±4.3) h vs (30.4±6.7) h, P＜0.001], and the former got significantly greater knee range of motion (ROM) than the latter [(69.3±7.3)° vs (64.8±6.9)°, P=0.005] 8 hours postoperatively and [(70.1±6.3)° vs (65.2±6.7)°, P=0.001] 24 hours after surgery. The VAS scores for pain in both groups significantly increased from 2h to 24h after surgery, whereas which in the combined group proved significantly lower than those in the ACB group at all time points postoperatively (P＜0.05). In addition, the combined group was also significantly better than the ACB group in terms of first remedy analgesia time [(6.3±1.8) h vs (10.4±2.3) h, P＜0.001], analgesia pump pressure times [(3.0±0.5) times vs (5.7±0.7) times, P＜0.001], the use of vasoactive drugs [(1.0± 0.2) times vs (1.7±0.4) times, P＜0.001], and the use of additional analgesics [(1.4±0.4) time vs (1.9±0.6) times, P＜0.001]. [Conclusion] The ACB combined with IPACK blocks do reduce pain after TKA, improve knee joint motion and shorten recovery time.