Application of dexamethasone plus ropivacaine for continuous femoral nerve block in postoperative analgesia of patients undergoing total knee arthroplasty
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摘要:
目的 比较罗哌卡因联合地塞米松连续股神经阻滞（连续股神经阻滞）与单纯罗哌卡因连续股神经阻滞用于人工全膝关节置换术（TKA）患者术后镇痛效果。 方法 选取本院及开平市中心医院40例拟行TKA患者随机分成对照组和试验，每组20例，所有患者术后在B超下行连续股神经阻滞麻醉。对照组镇痛药物为2.5 g/L罗哌卡因150 mL；试验组镇痛药物为2.5 g/L罗哌卡因和0.1 g/L 地塞米松混合液150 mL。记录所有患者不同时间点静息状态疼痛视觉模拟（VAS）评分，主、被动功能训练VAS评分，吗啡用量，主动屈曲关节角度以及麻醉相关不良反应。 结果 试验组6、12、24、48、72 h静息状态VAS评分均低于对照组，差异有统计学意义（P<0.05）。试验组术后24、48、72 h主、被动功能训练VAS评分均低于对照组（P<0.05）。试验组与对照组患者术后6 h后各时间段及72 h总吗啡用量均低于对照组（P<0.05）。试验组患者术后24、48、72 h患肢主动关节屈曲角度均大于对照组（P<0.05）。对照组麻醉相关不良反应发生率为30%，试验组为15%，两组患者麻醉相关不良反应发生率差异无统计学意义（P>0.05）。 结论 与单纯罗哌卡因相比，罗哌卡因联合地塞米松连续股神经阻滞可加强TKA患者的术后镇痛作用，提高TKA患者术后康复锻炼效果，减少阿片类药物的使用，且并发症发生率低，值得推广。 Abstract:Objective To compare the analgesic effect of dexamethasone plus ropivacaine and ropivacaine for continuous femoral nerve block in postoperative analgesia of patients undergoing unilateral total knee arthroplasty (TKA). Methods Forty patients undergoing TKA were randomly assigned to the control group and the experimental group, and were given continuous femoral nerve block guided by b-ultrasound. Patients in the control group were given 150 ml 2.5 g/L ropivacaine and those in the experimental group were given 150 ml 2.5 g/L ropivacaine and 0.1 g/L dexamethasone. Visual analog scale (VAS) in rest and in active and passive rehabilitation exercise, morphine consumption, the range of active knee flexion and opioids-related adverse effects were recorded at different time points. Results Postoperative VAS scores in rest at 6, 12, 24, 48 and 72 h and in active and passive rehabilitation exercise at 24, 48 and 72 h in the experimental group were significantly lower than those in the control group (P<0.05). Morphine consumptions in periods of time after 6 h and in 72 h were significantly less in the the experimental group than those in the control group (P<0.05). The postoperative range of active knee flexions at 24, 48 and 72 h in the experimental group were significantly larger than those in the control group (P<0.05). Moreover, the rate of adverse effects was 15% in the experimental group while that was 30% in the control group, and there was no significant difference between them (P>0.05). Conclusion Dexamethasone plus ropivacaine provided better postoperative analgesia than ropivacaine for continuous femoral nerve block in patients undergoing TKA. With low rate of adverse effects, it could enhance recovery after surgery and reduce opioid consumptions, which is worth popularizing. -
Key words:
- ropivacaine /
- dexamethasone /
- continuous femoral nerve block /
- total knee arthroplasty
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表 1 两组患者术后各时间点静息状态VAS评分比较（分，Mean±SD）
组别 1 h 2 h 6 h 12 h 24 h 48 h 72 h 对照组 1.1±0.5 1.3±0.6 3.1±2.2 4.5±3.1 4.4±2.9 3.2±2.2 2.9±2.4 试验组 0.9±0.5 1.1±0.4 1.8±1.5* 2.6±2.0* 2.5±2.2* 2.0±1.3* 1.5±1.5* *P<0.05vs 对照组. 
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表 2 两组患者术后各时间点主动功能训练VAS评分比较（分，Mean±SD）
组别 24 h 48 h 72 h 对照组 4.8±3.1 3.9±2.7 3.1±2.5 试验组 2.6±2.9* 2.1±1.6* 1.7±1.6* *P<0.05vs 对照组.
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表 3 两组患者术后各时间点被动功能训练VAS评分比较（分，Mean±SD）
组别 24 h 48 h 72 h 对照组 5.3±3.4 4.5±2.4 3.7±2.6 试验组 2.8±2.3* 2.4±1.8* 1.9±1.7* *P<0.05vs 对照组.
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表 4 两组患者术后各时间段吗啡用量比较（mg，Mean±SD）
组别 0~6 h 6~12 h 12~24 h 24~48 h 48~72 h 72 h总量 对照组 0.3±0.5 2.8±2.3 3.3±2.5 2.3±1.7 1.8±1.1 10.5±5.8 试验组 0.2±0.3 1.6±1.1* 1.8±1.3* 1.3±0.8* 1.1±0.7* 6.1±3.1* *P<0.05vs 对照组.
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表 5 两组患者术后各时间点主动关节屈曲角度比较（Mean±SD）
组别 24 h 48 h 72 h 对照组 31.3°±8.2° 53.1°±10.3° 67.2°±11.7° 试验组 38.2°±8.9°* 61.9°±11.2°* 74.7°±10.5°* *P<0.05vs 对照组.
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