CAJ | 학술논문

目的：对比多模式镇痛下收肌管阻滞与股神经阻滞对全膝关节置换术（total knee arthroplasty，TKA）术后初期镇痛及早期康复的影响。方法将80例拟行初次单侧TKA手术的患者随机分为收肌管阻滞组与股神经阻滞组。均于术前3天给予塞来昔布口服（200 mg，2次/d）。收肌管阻滞组术前30 min行术侧收肌管阻滞（5 g/L罗哌卡因20 ml+0.1 mg肾上腺素）；股神经阻滞组术前30 min行术侧股神经阻滞（3.33 g/L罗哌卡因30 ml+0.1 mg肾上腺素）。假体安放完毕后均行局部浸润镇痛（2.5 g/L罗哌卡因20 ml+0.1 mg肾上腺素），术后口服双氯酚酸钠、盐酸羟考酮缓释片及肌注帕瑞昔布直至出院。观察两组患者术后2、6、12、24、48、72 h的静息与活动状态下数字分级法疼痛评分（numeric rating scales，NRS）及股四头肌肌力；术后第1、2、3、14天的膝关节活动度、术后住院天数、术后补救性盐酸哌替啶用量及镇痛相关不良反应发生率。结果收肌管阻滞组术后各时点的静息及运动NRS评分均与股神经阻滞组接近。收肌管阻滞组术后24 h内肌力[（3.53±0.84）级]和术后第1、2、3天的膝关节活动度（分别为70.66°±16.38°、90.33°±13.66°、104.30°±11.70°）均高于股神经阻滞组，术后平均住院天数[（4.56±0.59）d]少于股神经阻滞组。收肌管阻滞组术后第14天的膝关节活动度、术后补救性盐酸哌替啶用量、镇痛相关不良反应发生率与股神经阻滞组相似。结论多模式镇痛下收肌管阻滞对TKA术后初期镇痛的效果与多模式镇痛下股神经阻滞相当。但与股神经阻滞相比，收肌管阻滞更有利于患者术后早期康复。
목적：대비다모식진통하수기관조체여고신경조체대전슬관절치환술（total knee arthroplasty，TKA）술후초기진통급조기강복적영향。방법장80례의행초차단측TKA수술적환자수궤분위수기관조체조여고신경조체조。균우술전3천급여새래석포구복（200 mg，2차/d）。수기관조체조술전30 min행술측수기관조체（5 g/L라고잡인20 ml+0.1 mg신상선소）；고신경조체조술전30 min행술측고신경조체（3.33 g/L라고잡인30 ml+0.1 mg신상선소）。가체안방완필후균행국부침윤진통（2.5 g/L라고잡인20 ml+0.1 mg신상선소），술후구복쌍록분산납、염산간고동완석편급기주파서석포직지출원。관찰량조환자술후2、6、12、24、48、72 h적정식여활동상태하수자분급법동통평분（numeric rating scales，NRS）급고사두기기력；술후제1、2、3、14천적슬관절활동도、술후주원천수、술후보구성염산고체정용량급진통상관불량반응발생솔。결과수기관조체조술후각시점적정식급운동NRS평분균여고신경조체조접근。수기관조체조술후24 h내기력[（3.53±0.84）급]화술후제1、2、3천적슬관절활동도（분별위70.66°±16.38°、90.33°±13.66°、104.30°±11.70°）균고우고신경조체조，술후평균주원천수[（4.56±0.59）d]소우고신경조체조。수기관조체조술후제14천적슬관절활동도、술후보구성염산고체정용량、진통상관불량반응발생솔여고신경조체조상사。결론다모식진통하수기관조체대TKA술후초기진통적효과여다모식진통하고신경조체상당。단여고신경조체상비，수기관조체경유리우환자술후조기강복。
Objective To compare adductor canal block with femoral nerve block under multimodal analgesia for early analgesic effect and rehabilitation after total knee replacement (TKA). Methods Eighty patients who were scheduled to undergo TKA were randomly divided into two groups:adductor canal block (ACB) group and femoral nerve block (FNB) group. All the pa?tients were given Celecoxib (200 mg, bid) three days preoperative. The ACB group was given adductor canal block with ropivacaine (5 g/L, 20 ml) and 0.1 mg epinephrine half an hour before the surgery. The FNB group was given femoral nerve block with ropivacaine (3.33 g/L, 30 ml) and 0.1 mg epinephrine half an hour before the surgery. Both of the two groups were given local infiltration analge?sia with ropivacaine (2.5 g/L, 20 ml) and 0.1 mg epinephrine after click into the prosthesis. After surgery, all the patients were given Diclofenac Sodium (50 mg, q12h, p.o.), oxycodone hydrochloride sustained?release tablets (10 mg, q12 h, p.o.) and Parecoxib (40 mg, q12 h, i.m.) until discharged. The resting and motion Numeric Rating Scales (NRS) scores, the knee joint range of motion, the muscle strength of quadriceps femoris, total Meperidine hydrochloride consumption, postoperative hospital stay and the side effects and complications were recorded. Results The resting and motion NRS scores were similar to the ACB group of FNB group which were not statistically significant. The range of motion (1, 2, 3 days after surgery) and muscular strength of quadriceps femofis (within 24 hours) in the ACB group was better than in the FNB group. The average length of postoperative hospital stay was shorter in the ACB group than it was in FNB group. In the ACB group the range of motion at 14 day, total Meperidine hydrochloride con?sumption and the side effects were similar to the FNB group. Conclusion Under multimodal analgesia, the adductor canal block had similar early analgesia effects with the femoral nerve block when TKA was performed. However, compared with FNB, the ACB was more beneficial to patients regarding the early postoperative rehabilitation to patient.