鞘内吗啡联合连续股神经阻滞用于全膝关节置换术后早期康复镇痛的临床观察被引量：23

CLINICAL OBSERVATION OF COMBINED INTRATHECAL MORPHINE WITH CONTINUOUS FEMORAL NERVE BLOCKADE FOR POSTOPERATIVE REHABILITATION PAIN AFTER TOTAL KNEE ARTHROPLASTY SURGERY

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摘要目的：观察鞘内注射吗啡联合连续股神经阻滞用于全膝关节置换术后早期康复镇痛的效果。方法：选择ASAⅠ～Ⅲ级行单侧全膝关节置换患者40例，随机分为2组：连续股神经阻滞组（FNB，n=20）和鞘内吗啡联合连续股神经阻滞组（MFB，n=20）。所有患者麻醉前留置股神经导管，在椎管内麻醉下实施膝关节置换手术。MFB组患者在给予腰麻药物后经腰麻针注入无防腐剂吗啡0．15mg（用生理盐水稀释至1ml），两组患者术后都通过留置导管持续输注0．2％盐酸罗哌卡因5ml／h镇痛。分别记录术后6h、24h、48h及72h各时点患者休息时、主动功能锻炼时的VAS评分，术后24h、48h和72h患者被动功能锻炼时VAS评分及患肢被动弯曲度；观察两组患者的镇静程度及是否存在缺氧；比较两组患者的并发症发生率和满意度差异。结果：MFB组患者在术后各时点的VAS静患和运动痛评分低于FNB组患者，（P〈0．05）；MFB组患者的膝关节弯曲度略高于FNB组患者，但无统计学差异（P〉0．05）；两组无过度镇静病例，术后6h均能顺利脱鼻氧；总体上看，两组并发症发生率均较低，MFB组患者除了发生恶心呕吐病例多于FNB组外（P〈0．05），其余并发症发生率无统计学差异；相应，MFB组镇痛满意度要高于FNB组患者（P〈0．05）。结论：鞘内吗啡联合连续股神经阻滞，在术后早期能显著改善镇痛效果，除恶心呕吐外，吗啡相关并发症无明显增加，是TKA术后早期较为理想的镇痛方法。 Objective： To observe the effect of combined intratheeal morphine with continuous femoral nerve block on postoperative early rehabilitation pain after total knee arthroplasty （TKA） surgery. Methods： Forty patients , ASA Ⅰ-Ⅲ , undergoing unilateral TKA surgery , were randomly divided into two groups ： group FNB （n = 20） and group MFB （n = 20）. Femoral catheters were placed before performing combined subarachnoid and epidural anesthesia for all patients. For patients in group MFB, 0.15rag morphine with preservative free was injected into the subarachnoid space through the lumbar anesthesia needle after anesthesia procedure. After operation all patients were pumped with 0.2% Hydrochloric acid Ropivacaine, 5mL/h through the indwelling catheter. VAS pain scores during rest and active exercise were recorded at time point of postoperative 6h, 24h, 48h and 72h. Likewise, VAS pain scores during passive exercise and bending degree of operated limb were recorded at time point of postoperative 24h, 48h and 72h respectively. Patients＇ Ramesay sedation scores, oxygen saturation, satisfying degree and complications were also observed in two groups. Results： In general, patients＇VAS pain scores were un- der middle degree in both groups. VAS pain scores during rest and exercise at all timepoints in group MFB were lower than those in group FNB （P 〈 0.05 ）. Accordingly, the bending degree of knee joints in group MFB were little greater than that in group FNB （P 〉 0.05 ）. There were no excess sedative and anoxia cases in both groups. Compared with group FNB, the incidence of side effects were not significantly increased in group MFB except nausea and vomiting scores. The patients in group MFB have higher satisfying scores than group FNB （P = 0. 042）. Conclusion： After TKA surgery, combined intrathecal morphine with continuous femoral nerve blockade can provide better pain relief without markedly increasing the incidence of side effects except nausea and vomiting. So this method could be the better choice to control pain in early stage of postoperation.

作者南兴东李水清贾东林张利萍郭向阳冯艺

机构地区北京大学第三医院麻醉科北京大学人民医院麻醉科

出处《中国疼痛医学杂志》 CAS CSCD 2010年第4期215-219,共5页 Chinese Journal of Pain Medicine

关键词膝关节置换术后镇痛吗啡股神经阻滞 Total knee arthroplasty Postoperative analgesia Morphine Femoral nerve blockade

分类号 R614 [医药卫生—麻醉学]

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