超声引导下收肌管阻滞两种药物在全膝关节置换术镇痛比较（开放获取）

Analgesic comparison of two kinds of drugs used in adductor block guided by ultrasound in total knee arthroplasty

摘要:

［目的］比较超声引导下布比卡因脂质体 (liposomal bupivacaine, LB) 与罗哌卡因（ropivacaine, ROP）收肌管阻滞在全膝关节置换术 (total knee arthroplasty, TKA) 的镇痛效果。［方法］选择 2024 年 2 月—2024 年 11 月 98 例老年 TKA 患者，以随机数字表法分为两组。应用超声引导下收肌管阻滞，给予 LB 49 例，ROP 49 例，比较两组临床和镇痛资料。［结果］两组患者均顺利完成手术，术中无严重并发症。两组围手术期不良反应发生率的差异无统计学意义（P>0.05）。LB 组术后 48 h 的 30 s 椅子站立测试（30-second chair-stand test, 30 s-CST）显著优于 ROP 组 [(3.5±0.7) 次 vs (3.0±0.4) 次, P<0.001]；但是，两组间计时起立测试（timed up and go, TUG）的差异无统计学意义（P>0.05）。镇痛方面，术后 12、24、48、72 h LB 组在静息和活动状态下 VAS 评分均显著优 ROP 组（P<0.05）。此外，LB 组的术后首次按压镇痛泵时间 [(20.8±2.4) h vs (10.1±1.3) h, P<0.001]和术后 24 h 补救镇痛率（6.1% vs 28.6%, P=0.003）均显著优于 ROP 组。［结论］老年 TKA 超声引导收肌管阻滞，LB 在改善其术后早期膝关节功能， 减轻早期疼痛程度方面，均优于 ROP。

Abstract:

[Objective] To compare the analgesic effects of ultrasound-guided adductor block with liposomal bupivacaine (LB) versus ropivacaine (ROP) in total knee arthroplasty (TKA). [Methods] A total of 98 elderly patients who were undergoing TKA from February 2024 to November 2024 were included in this study and divided into two groups by random number table method. Before operation, the ultrasound-guided adductor block was conducted with corresponding drugs. The clinical and analgesic data of the 49 patients with LB and the 49 patients with ROP were compared. [Results] TKA was successfully completed in both groups without serious complications. There was no significant difference in the incidence of perioperative adverse reactions between the two groups (P＞0.05). The LB group proved significantly superior to the ROP group in term of 30-second chair-stand test (30s-CST) 48h after surgery [(3.5±0.7) times vs (3.0±0.4) times, P 0.001], despite of the fact there was no significant difference in TUG between the two groups (P＞0.05). Regarding to analgesia, the LB group was significantly better than the ROP group in VAS scores at resting and active conditions 12 hours, 24 hours, 48 hours and 72 hours postoperatively (P＜0.05). In addition, the LB was also proved significantly superior to the ROP group in terms of time to press the analgesic pump firstly [(20.8±2.4) hours vs (10.1±1.3) hours, P 0.001] and salvage analgesic use rate 24 hours after surgery (6.1% vs 28.6%, P=0.003). [Conclusion] The LB used in ultrasound-guided adductor block is superior to ROP in terms of improving early knee function and reducing early pain in total knee arthroplasty in the elderly