收肌管阻滞在膝关节镜术后早期镇痛中的临床应用

Clinical observation of adductor canal block in postoperative early analgesia of knee arthroscopic surgery*

摘要:

摘要：目的??分析膝关节镜术后采用收肌管阻滞早期镇痛的有效性与安全性，为未来膝关节镜术后镇痛方案的选择提供参考。方法 选择该院择期接受初次单侧膝关节镜下半月板手术治疗的患者60例，根据随机数字表法将其分为收肌管阻滞组（ACB组）与浸润麻醉组（IA组），每组30例，患者术中麻醉方式均为全身麻醉，麻醉诱导与麻醉维持方法一致。手术前30?min给予ACB组收肌管阻滞早期镇痛，给予IA组浸润麻醉早期镇痛，记录围手术期相关指标，并对比两组并发症发生情况。在术后1、2、4、8和12?h采用视觉模拟评分法（VAS）评估患者疼痛情况，用来评价其镇痛效果；分别于术后各时点，采用徒手肌力法评价患者股四头肌肌力；并对比两组镇痛有效率和肌力减弱发生率。结果 术后1、2和4?h，两组患者VAS评分比较，差异无统计学意义（P?>?0.05）；术后8和12?h，ACB组VAS评分较IA组降低，且曲马多使用量少于IA组，差异均有统计学意义（P??0.05）。结论 术前超早期给予膝关节镜手术患者收肌管阻滞，患者术后早期镇痛效果较传统浸润麻醉好，可以减少曲马多的使用，且对患者股四头肌肌力无明显负面影响，肌力减弱情况少，无严重并发症发生，安全可靠，值得推广应用。

Abstract:

Abstract: Objective?To analyze the effectiveness and safety of adductor canal block in postoperative early analgesia of knee arthroscopic surgery, and provide reference for the choice of postoperative analgesia regimen of knee arthroscopic surgery.?Methods?60 patients who met the standard for the first unilateral knee arthroscopic lower meniscus surgery were selected, they were divided into adductor canal block group (ACB group) and infiltration anesthesia group (IA group) according to the random number table method, with 30 cases in each group. All these patients were given intraoperative general anesthesia, the methods of anesthesia induction and anesthesia maintenance were consistent. 30 min before the surgery, ACB group was given early analgesia with adductor canal block, while IA group was given early analgesia with infiltration anesthesia. The perioperative complications in the two groups were recorded and compared. The visual analogue scale (VAS) was adopted to evaluate the postoperative 1 h, 2 h, 4?h, 8?h, 12 h pain degree of patients, so as to assess its analgesic effect; At each time-point after surgery, the quadriceps femoris muscle strength was evaluated by manual muscle test; The effective rate of analgesia and the incidence of low muscle strength were compared between the two groups.?Results?There was no statistical difference in the postoperative 1?h, 2 h, 4 h VAS scores between the two groups (P?>?0.05); The postoperative 8 h and 12 h VAS scores in ACB group were lower than those in IA group, and the dose of Tramadol in ACB group was less than that in IA group (P??0.05).?Conclusion?Adductor canal block in postoperative early analgesia of knee arthroscopic surgery has better analgesic effects than conventional infiltration anesthesia analgesia, and it can reduce the dose of Tramadol, it has no significant adverse effect on quadriceps femoris muscle strength, reduces the incidence of low muscle strength, and has no severe complications, which is safe and reliable and worthy of promotion.