右美托咪定复合低浓度罗哌卡因单次股神经阻滞对老年患者膝关节置换术的影响OA
Effect of Single Femoral Nerve Block with Dexmedetomidine Combined with Low Concentration Ropivacaine on Knee Arthroplasty in Elderly Patients
目的 探讨右美托咪定复合低浓度罗哌卡因单次股神经阻滞在老年患者膝关节置换术后的镇痛效果及对术后肌力恢复的影响.方法 选取深圳市龙岗区骨科医院2020年3月-2021年9月在喉罩插管全麻下行膝关节置换术(TKA)患者60例,采用数字表法随机分为实验组(DR组)和对照组(R组)各30例.DR组与R组分别以0.15％罗哌卡因+1 μg/kg右美托咪啶、0.15％罗哌卡因超声引导下股神经阻滞,术后两组均行患者自控静脉镇痛(PCIA).比较两组患者术后不同时间点(4、8、12、18、24、48 h)疼痛程度(VAS)及股四头肌肌力.记录两组患者术后PCIA首次按压时间、术后48 h内各时间间隔PCA按压次数、相关并发症,以及不良反应发生情况.结果 DR组术后8、12、24h静息状态VAS评分及运动状态VAS评分均低于R组(P＜0.05);两组术后股四头肌肌力比较,差异无统计学意义(P＞0.05);DR组患者首次PCA按压时间为(5.64±1.73)h,长于R组的(3.15±1.52)h,差异有统计学意义(P＜0.05);DR组术后4～8 h、8～12 h、12～24 h时间间隔PCA按压次数少于R组(P＜0.05);两组不良反应发生率比较,差异无统计学意义(P＞0.05).结论 与单纯罗哌卡因相比,右美托咪定复合低浓度罗哌卡因能增强阻滞效果,延长术后镇痛时间,对术后肌力恢复的影响较小,且不会增加不良反应,能为TKA患者提供更好的镇痛效果.
Objective To investigate the effect of single femoral nerve block with dexmedetomidine combined with low concentration ropivacaine on postoperative analgesia and postoperative muscle strength recovery in elderly patients after knee arthroplasty.Methods A total of 60 patients undergoing total knee arthroplasty(TKA)under general anesthesia with laryngeal mask intubation from March 2020 to September 2021 in Shenzhen Longgang Orthopaedics Hospital were selected and randomly divided into experimental group(DR group)and control group(R group),with 30 patients in each group.DR group and R group were treated with 0.15％ropivacaine+1 μg/kg dexmedetomidine and 0.15％ropivacaine for ultrasound-guided femoral nerve block,respectively.Postoperative patient-controlled intravenous analgesia(PCIA)was performed in both groups.The pain degree(VAS)and quadriceps muscle strength at different time points(4,8,12,18,24,48 h)after operation were compared between the two groups.The first pressing time of PCIA after operation,the times of PCA pressing at each time interval within 48 h after operation,related complications and adverse reactions were recorded in the two groups.Results The VAS score of resting state and motion state at 8,12 and 24 h after operation in DR group was lower than that in R group(P＜0.05).The first PCA pressing time of DR group was(5.64±1.73)h,which was longer than(3.15±1.52)h of R group,and the difference was statistically significant(P＜0.05).The times of PCA pressing at 4-8 h,8-12 h and 12-24 h after operation in DR group were less than those in R group(P＜0.05).There was no significant difference in the incidence of adverse reactions between the two groups(P＞0.05).Conclusion Compared with ropivacaine alone,dexmedetomidine combined with low concentration ropivacaine can enhance the block effect,prolong the postoperative analgesia time,have less effect on the recovery of postoperative muscle strength,and will not increase the adverse reactions,which can provide better analgesic effect for TKA patients.
李严棠;覃军;李捷;傅翔;李波
深圳市龙岗区骨科医院麻醉科,广东 深圳 518116深圳市龙岗区骨科医院骨科,广东 深圳 518116
临床医学
右美托咪啶股神经阻滞全膝关节置换术后镇痛
DexmedetomidineFemoral nerve blockTotal knee arthroplastyPostoperative analgesia
《医学信息》 2024 (009)
112-117 / 6
1.深圳市龙岗区经济与科技发展专项资金医疗卫生科技计划项目(编号:LGWJ2022105);2.龙岗区医学重点学科建设经费资助项目(编号:深龙卫健通[2024]1号)
评论