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中华老年骨科与康复电子杂志

中华老年骨科与康复电子杂志 ›› 2022, Vol. 08 ›› Issue (06) : 367 -373. doi: 10.3877/cma.j.issn.2096-0263.2022.06.008

麻醉医学

超声引导下不同位置收肌管阻滞用于老年全膝关节置换术后的镇痛效果观察
周立杰1, 王现雷1, 吴振宇1, 刘文超1, 于洋1,†()   
  1. 1. 066000　秦皇岛市第一医院麻醉科
  • 收稿日期:2022-07-07 出版日期:2022-12-05
  • 通信作者: 于洋
  • 基金资助:
    秦皇岛科技局项目(202101A045)

The analgesic effect of different position adductor canal block guided by ultrasound for senile patients after total knee arthroplasty

Lijie Zhou1, Xianlei Wang1, Zhenyu Wu1, Wenchao Liu1, Yang Yu1,†()   

  1. 1. Department of Anesthesiology, First Hospital of Qinhuangdao, Qinhuangdao 066099, China
  • Received:2022-07-07 Published:2022-12-05
  • Corresponding author: Yang Yu
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周立杰, 王现雷, 吴振宇, 刘文超, 于洋. 超声引导下不同位置收肌管阻滞用于老年全膝关节置换术后的镇痛效果观察[J/OL]. 中华老年骨科与康复电子杂志, 2022, 08(06): 367-373.

Lijie Zhou, Xianlei Wang, Zhenyu Wu, Wenchao Liu, Yang Yu. The analgesic effect of different position adductor canal block guided by ultrasound for senile patients after total knee arthroplasty[J/OL]. Chinese Journal of Geriatric Orthopaedics and Rehabilitation(Electronic Edition), 2022, 08(06): 367-373.

目的

探讨超声引导下不同位置收肌管阻滞用于老年患者在全身麻醉下接受单侧全膝关节置换术后的镇痛效果。

方法

前瞻性收集2019年9月10日至2021年6月30日于秦皇岛市第一医院接受单侧膝关节置换术的老年患者64例，男性34例，女性30例，年龄65~83岁，按照随机数字表法分为两组（n=32），对照组采用超声引导下近端收肌管阻滞，观察组为远端收肌管阻滞。记录两组手术情况包括手术时间，神经阻滞操作时间，术中出血量和术后48 h内引流量，比较两组患者术后疼痛程度、镇痛泵按压和镇痛补救次数、股四头肌肌力以及膝关节活动情况。

结果

64例患者均获得随访，随访时间10~12个月。两组患者在手术时间、神经阻滞操作时间、术中出血量、术后引流量、术后镇痛药物补救方面差异无统计学意义。两组患者VAS评分和患肢活动情况进行重复测量方差分析，结果显示静息状态下VAS评分不同时间点之间差异有统计学意义（F=29.342，P=0.000）。活动时VAS评分两组间差异有统计学意义（F=12.295，P=0.001），不同时间点之间差异有统计学意义（F=3.373，P=0.010）。术后股四头肌肌力两组患者之间差异有统计学意义（F=6.918，P=0.011），两组术后膝关节活动度有差异（F=7.263，P=0.009），不同时间点差异有统计学意义（F=25.238，P=0.000）。

结论

远端收肌管阻滞为老年全麻下膝关节置换术后提供较为理想的镇痛效果，对股四头肌肌力影响较小，有利于早期运动功能恢复。

关键词: 超声引导, 收肌管阻滞, 膝关节置换术, 术后镇痛
Objective

To investigate the analgesic effect of ultrasound guided adductor tube block in different positions in elderly patients undergoing unilateral total knee arthroplasty under general anesthesia.

Methods

64 elderly patients (34 males, 30 females, 65-83 years old) who underwent unilateral knee arthroplasty in the First Hospital of Qinhuangdao from September 10, 2019 to June 30, 2021 were prospectively collected and divided into two groups according to the random number table method (n=32).The control group received ultrasound-guided proximal adductor tube block. Observation group was distal adductor tube block.The operation time, nerve block operation time, intraoperative blood loss and drainage volume within 48 hours after operation were recorded. The degree of postoperative pain, times of analgesic pump compression and analgesic relief, quadriceps muscle strength and knee joint activity were recorded.

Results

All 64 patients were followed up for 10-12 months. There were no significant differences in operation time, nerve block operation time, intraoperative blood loss, postoperative drainage volume, and postoperative analgesic drug recovery between the two groups. The VAS score and limb activity of the two groups at different time points after operation were analyzed by repeated measures ANOVA. The results showed that there were statistically significant differences in VAS score at different time points in the resting state (F=29.342, P=0.000). There was a significant difference in VSA score between the two groups at the time of activity (F=12.295, P=0.001), and there was a significant difference between the two groups at different time (F=3.373, P=0.010). Postoperative quadriceps muscle strength was significantly different between the two groups (F=6.918, P=0.011), knee joint range of motion was significantly different between the two groups (F=7.263, P=0.009), and the difference was statistically significant at different time points (F=25.238, P=0.001).

Conclusion

Distal adductor tube block can provide ideal analgesic effect for elderly patients after knee arthroplasty under general anesthesia. It has little effect on quadriceps muscle strength and is beneficial to early recovery of motor function.

Key words: Ultrasonic guidance, Adductor canal block, Total knee arthroplasty, Postoperative analgesia
表1 两组老年全膝关节置换术后患者一般资料比较
组别 例数 性别（例，男/女） 年龄（岁， ±s ） ASA（例，Ⅱ/Ⅲ） BMI（kg/m2， ±s ） 术前并发症（例）
高血压 糖尿病 冠心病
对照组 32 18/14 70.47±5.08 20/12 23.93±3.48 22 12 15
观察组 32 16/16 71.75+4.84 21/11 23.91±3.24 20 18 19
统计值   χ2=0.251 t=1.033 χ2=0.068 t=0.028 χ2=0.277 χ2=2.259 χ2=1.004
P值   0.616 0.306 0.794 0.978 0.793 0.133 0.316
图3 超声探头沿大腿长轴方向由近端向远端滑动定位穿刺位置。SM：缝匠肌；VMM：股内侧肌；AMM：大收肌；ALM：长收肌；FA：股动脉；SN：隐神经；LA：局麻药
表2 两组老年全膝关节置换术患者手术情况比较（±s）
组别 例数 手术时间（min） 操作时间（min） 出血量（ml） 引流量（ml）
对照组 32 98±10 9.2±2.3 69±19 234±36
观察组 32 97±11 8.7±1.8 67±19 222±34
t值   0.293 0.844 0.533 1.429
P值   0.770 0.402 0.596 0.158
表3 两组老年全膝关节置换术后患者术后静息状态下VAS评分的比较（分，±s）
组别 例数 术后4 h 术后8 h 术后12 h 术后24 h 术后48 h F值 P值
对照组 32 1.68±0.69 2.47±0.72 2.72±0.68 2.68±0.78 2.21±0.49 11.932 0.000
观察组 32 1.44±0.62 2.50±0.62 2.41±0.71 2.71±0.85 2.03±0.54 15.055 0.000
F值   2.318 0.035 3.209 0.023 2.122    
P值   0.133 0.853 0.078 0.879 0.150    
表4 两组老年全膝关节置换术后患者术后活动时VAS评分的比较（分，±s）
组别 例数 术后4 h 术后8 h 术后12 h 术后24 h 术后48 h F值 P值
对照组 32 3.84±0.77 4.03±0.69 4.22±0.71 4.13±0.79 4.22±0.75 2.114 0.090
观察组 32 3.63±0.61 3.63±0.61 3.75±0.67 3.72±0.63 4.00±0.57 1.828 0.135
F值   1.597 6.185 7.397 5.121 1.728    
P值   0.211 0.016 0.008 0.027 0.193    
表5 两组老年全膝关节置换术后患者镇痛泵按压次数和镇痛药补救次数（次，±s）
组别 例数 镇痛泵按压次数 镇痛药物补救次数
对照组 32 3.16±1.19 1.72±0.81
观察组 32 2.87±1.10 1.56±0.80
t值   0.980 0.775
P值   0.331 0.441
表6 两组老年全膝关节置换术后不同时间点股四头肌肌力比较（级，±s）
组别 例数 术后12 h 术后24 h 术后48 h F值 P值
对照组 32 3.69±0.69 4.43±0.50 4.60±0.49 17.354 0.000
观察组 32 3.96±0.60 4.59±0.51 4.78±0.42 13.600 0.000
F值   3.036 0.244 2.645    
P值   0.086 0.623 0.109    
表7 两组老年全膝关节置换术后不同时间点膝关节活动度比较（°，±s）
组别 例数 术后12 h 术后24 h 术后48 h F值 P值
对照组 32 68.97±6.21 76.41±6.12 78.12±7.27 18.937 0.000
观察组 32 73.60±4.96 77.81±5.95 78.90±5.35 6.259 0.030
F值   10.845 0.869 0.240    
P值   0.002 0.355 0.626    
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