[1]叶久敏,卿 忠,杨 光,等.超声引导下腘动脉与膝关节后囊间隙不同入路阻滞对全膝关节置换患者围术期镇痛效果观察*[J].陕西医学杂志,2020,49(11):1408-1411,1425.[doi:DOI:10.3969/j.issn.1000-7377.2020.11.010]
　YE Jiumin,QING Zhong,YANG Guang,et al.Analgesic effect of different approach block of IPACK under ultrasound guidance for patients with total knee arthroplasty[J].,2020,49(11):1408-1411,1425.[doi:DOI:10.3969/j.issn.1000-7377.2020.11.010]
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超声引导下腘动脉与膝关节后囊间隙不同入路阻滞对全膝关节置换患者围术期镇痛效果观察*
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《陕西医学杂志》[ISSN:1000-7377/CN:61-1281/TN]

卷:
49
期数:
2020年11期
页码:
1408-1411,1425
栏目:
临床研究
出版日期:
2020-11-05

文章信息/Info

Title:
Analgesic effect of different approach block of IPACK under ultrasound guidance for patients with total knee arthroplasty
作者:
叶久敏1; 卿 忠1; 杨 光1; 易双强1; 董补怀1; 崔自强2△
1.西安交通大学附属红会医院(西安 710054); 2.陕西省友谊医院(西安 710068)
Author(s):
YE Jiumin; QING Zhong; YANG Guang; et al.
Honghui Hospital Affiliated to Xi'an Jiaotong University(Xi'an 710054)
关键词:
腘动脉与膝关节后囊间隙阻滞;  收肌管阻滞;  全膝关节置换;  术后镇痛;  康复
Keywords:
Interspace between the popliteal artery and posterior capsule of the knee;  Adductor tube block;  Total knee arthroplasty;  Postoperative analgesia;  Rehabilitation
分类号:
R614.4
DOI:
DOI:10.3969/j.issn.1000-7377.2020.11.010
文献标志码:
A
摘要:
目的:观察超声引导下不同入路腘动脉与膝关节后囊间隙(IPACK)阻滞联合收肌管阻滞用于全膝关节置换术患者围术期镇痛效果。方法:选择拟行单侧人工全膝关节置换术患者112例,采用随机数字表法分为两组:IPACK近端入路组(A组,60例)和IPACK远端入路组(B组,52例)。全麻诱导成功后插入喉罩,A组采用超声引导下IPACK近端入路行IPACK阻滞联合收肌管阻滞,B组采用超声引导下IPACK远端入路行IPACK阻滞联合收肌管阻滞,收肌管阻滞均给予0.4% 盐酸罗哌卡因25 ml; IPACK阻滞均给予0.4% 盐酸罗哌卡因25 ml,术中静脉吸入复合全麻维持。观察手术后12、24、48、72 h静息状态、运动状态下疼痛视觉模拟评分(VAS),术后12、24、48、72 h膝关节的最大主动活动度、被动活动度,住院天数以及补救镇痛药物消耗量。结果:术后12、24、48 h 两组静息状态VAS评分、运动状态VAS评分比较差异有统计学意义(P<0.05),A组静息及运动状态VAS评分评分明显优于B组; 术后72 h 两组的静息及运动状态VAS评分比较差异无统计学意义(P>0.05); A组术后12、24、48 h膝关节主动、被动活动度明显优于B组,两组比较差异有统计学意义(P<0.05); 两组的72 h膝关节主动活动度、被动活动度、住院天数比较差异无统计学意义(P>0.05); 镇痛药物使用量A组明显少于B组,两组比较差异有统计学意义(P<0.05)。结论:近端入路IPACK阻滞联合收肌管阻滞用于全膝关节置换术在术后12、24、48 h静息及运动状态VAS评分、膝关节主被动活动度、镇痛药物使用量使用量方面明显优于IPACK远端入路,有利于患者术后快速康复,对于全膝关节置换术后患者可优先选择膝关节近端入路行IPACK间隙阻滞。
Abstract:
Objective:To observe the perioperative analgesic effect of interspace between the popliteal artery and the capsule of the posterior knee(IPACK)block combined with adductor tube block under ultrasound guidance for patients with total knee arthroplasty.Methods:A total of 112 patients planned to undergo unilateral total knee arthroplasty were selected and divided into IPACK proximal approach group(group A,60 cases)and IPACK distal approach group(group B,52 cases)by using a random number table method.A laryngeal mask was inserted after successful induction of general anesthesia.Group A underwent IPACK block combined with adductor tube block through IPACK proximal approach under ultrasound guidance,while group B underwent IPACK block combined with adductor tube block through IPACK distal approach under ultrasound guidance.0.4% ropivacaine hydrochloride 25 ml was given for adductor tube block and IPACK block,respectively.Intravenous inhalation combined with general anesthesia was maintained during the operation.The scores of Visual Analogue Scale(VAS)in resting state and exercise state at 12,24,48,72 hours after surgery,and the maximum active range of motion,passive range of motion of the knee joint at 12,24,48,72 hours after surgery,and the number of hospitalization days and the consumption of remedial analgesics were observed.Results:There was statistically significant difference in the VAS scores between the two groups at 12,24,and 48 hours after operation in resting state and exercise state(P<0.05).The VAS scores of group A in the resting and exercise state were significantly better than those of group B.There was no statistically significant difference in the VAS scores in resting state and exercise state at 72 hours after operation between the two groups(P>0.05).The active and passive motion of the knee joint in group A was significantly better than those in group B at 12,24,and 48 hours after operation(P<0.05).There was no significant difference in the active and passive range of motion at 72 hours after operation,and length of stay between the two groups(P>0.05).The use of analgesics in group A was significantly less than that in group B(P<0.05).Conclusion:In terms of VAS scores in resting state and exercise state,active and passive range of motion of the knee joint at 12,24,and 48 hours after surgery,and amount of analgesic drugs,IPACK block combined with adductor tube block through IPACK proximal approach is better than that through IPACK distal approach,which is conducive to the rapid recovery of patients after total knee arthroplasty.For patients after TKA,the proximal approach of the knee could be preferred to perform IPACK block.

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备注/Memo

备注/Memo:
*陕西省重点研发计划项目(2020SF-090)
更新日期/Last Update: 2020-11-05