全膝关节置换收肌管联合腘丛神经阻滞的效果

Effectiveness of adductor canal block combined with popliteal plexus block in total knee arthroplasty

摘要:

[目的] 探讨全膝关节置换术 （total knee arthroplasty, TKA） 收肌管 （adductor canal block, ACB） 阻滞联合腘丛神经阻滞 （popliteal plexus block, PPB） 的效果。[方法] 2022 年 1 月—2023 年 1 月因骨性关节炎在静吸复合麻醉下进行初次单侧 TKA 的 100 例患者纳入本研究，采用数字表法随机分为两组，其中，50 例采用 PPB 联合 ACB （联合组）；50 例采用 ACB （ACB 组）。比较两组临床与镇痛资料。[结果]两组术中出血量、手术时间、总不良反应差异无统计学意义（P＞0.05），联合组的下床时间 [(22.5±4.4) d vs (28.6±5.7) d, P＜0.001] 和出院时间 [(7.2±1.1) d vs (8.0±1.3) d, P＜0.001] 均显早于 ACB 组，术后 1、3 d 联合组的膝关节 ROM 均显著大于 ACB 组 [(88.4±15.8)° vs (67.7±14.5)°, P＜0.001; (96.6±17.9)° vs (83.5±15.7)°, P＜0.001]。镇痛资料方面，联合组术后 2~48 h 的 NRS 评分均显著低于 ACB 组（P＜0.05），术后 72 h 时两组间差异已无统计学意义（P＞0.05）。联合组首次按压镇痛泵时间显著晚于 ACB 组 [(7.4±2.0) h vs (5.5±1.6) h, P＜0.001]，此外，联合组镇痛泵按压次数、血管活性药物使用次数、补救镇痛例数均显著低于 ACB 组（P＜0.05）。[结论]PPB 联合 ACB 用于 TKA 术能够减轻术后早期疼痛症状，缩短卧床与住院时间，有利于膝关节 ROM 的恢复。

Abstract:

[Objective] To evaluate the effectiveness of adductor canal block (ACB) combined with popliteal plexus block (PPB) in total knee arthroplasty (TKA). [Methods] From January 2022 to January 2023, a total of 100 patients who underwent the primary unilateral TKA under intravenous and inhalant combined general anesthesia for knee osteoarthritis were included in this study, and randomly divided into two groups by random number table method. Of them, 50 patients received PPB combined ACB (the combined group), while the other 50 patients received ACB only (the ACB group). The clinical and analgesic data of the two groups were compared. [Results] There was no significant difference in intraoperative blood loss, operation time and total adverse reactions between the two groups (P＞0.05). The combined group proved significantly superior to the ACB group in terms of ambulation time [(22.5±4.4) days vs (28.6±5.7) days, P＜0.001] and hospital stay [(7.2±1.1) days vs (8.0±1.3) days, P＜0.001]. In addition, the combined group was also significantly superior to the ACB group in knee ROM 1 day and 3 days postoperatively [(88.4±15.8)° vs (67.7±14.5)°, P＜0.001; (96.6±17.9)° vs (83.5±15.7)°, P＜0.001]. As for analgesia data, the combined group had significantly lower NRS score than the ACB group from 2 hous to 48 hous after surgery (P＜0.05), despite of the fact that the difference between the two group became not statistically significant 72 hours after surgery (P＞0.05). Furthermore, the combined group was significantly superior to the ACB group regarding to the first time of analgesic pump compressed [(7.4±2.0) hours vs (5.5±1.6) hours, P＜0.001], the number of analgesic pump compression times, vasoactive drug use times and number of remedial analgesia (P＜0.05). [Conclusion] The use of PPB combined with ACB in TKA does alleviate early postoperative pain symptoms, shorten bed rest and hospital stay, and is conducive to the recovery of knee ROM.