股神经阻滞联合关节腔浸润麻醉在膝关节镜手术中的应用效果

doi:10.3760/cma.j.issn.1007-1245.2024.02.007

摘要/Abstract

摘要：

目的　评价股神经阻滞联合关节腔浸润麻醉在膝关节镜手术中的安全性和有效性。方法　选择滨州医学院附属医院骨关节外科2022年1月至6月因半月板损伤、游离体、骨性关节炎计划行单侧膝关节镜手术患者120例，随机分为股神经阻滞联合关节腔浸润麻醉组（F/I组）和腰硬联合麻醉组（CSEA组），每组60例。F/I组中男32例，女28例，年龄（38.75±11.35）岁；CSEA组中男25例，女35例，年龄（37.80±10.85）岁。比较两组术中补救例数、术后视觉模拟评分法（VAS）评分、术后感觉恢复时间及首次下地活动时间、术后并发症、住院花费及住院天数等指标的差异。采用t检验、χ²检验、Fisher确切概率法。结果　F/I组术后6 h VAS评分低于CSEA组［（2.08±0.61）分比（2.54±0.64）分］，差异有统计学意义（t=-2.484，P=0.018）。F/I组感觉恢复时间长于CSEA组［（6.25±0.40）h比（3.60±0.31）h，首次下地活动时间短于CESA组［（2.99±1.05）h比（8.14±1.88）h］，差异均有统计学意义（t=14.095、-12.263，均P<0.001）。术后并发症：F/I组术中加用麻醉发生率3.3%（2/60）、尿潴留发生率0、下肢静脉血栓发生率1.7%（1/60）、恶心呕吐发生率3.3%（2/60），CSEA组术中加用麻醉发生率0、尿潴留发生率10.0%（6/60）、下肢静脉血栓发生率5.0%（3/60）、恶心呕吐发生率16.7%（10/60），两组尿潴留、恶心呕吐发生率比较差异均有统计学意义（均P<0.05）。F/I组住院时间为（3.90±0.63）d、住院费用为（9 612.67±507.15）元，CESA组分别为（5.27±0.75）d、（11 401.52±530.01）元，差异均有统计学意义（t=-8.862、-15.425，均P<0.001）。结论　股神经阻滞联合关节腔浸润麻醉在膝关节镜手术中能够减少术后并发症、缩短住院时间、降低住院费用，并提供良好的麻醉效果。

关键词:

股神经阻滞, 腰硬联合麻醉, 膝关节镜手术, 关节腔浸润麻醉, 半月板损伤, 术后并发症

Abstract:

Objective　To evaluate the effect and safety of femoral nerve block combined with intra-articular anaesthesia in knee arthroscopy. Methods　A total of 120 patients who planned to undergo unilateral knee arthroscopic surgery due to meniscus injury, loose body, or osteoarthritis in Department of Bone and Joint Surgery, Binzhou Medical University Hospital from January to June 2022 were selected. The patients were randomly divided into a femoral nerve block combined with joint cavity infiltration anesthesia group (F/I group) and a combined spinal-epidural anesthesia group (CSEA group), with 60 patients in each group. In the F/I group, there were 32 males and 28 females, aged (38.75±11.35) years. In the CSEA group, there were 25 males and 35 females, aged (37.80±10.85) years. The differences in the number of intraoperative rescue cases, postoperative Visual Analogue Scale (VAS) score, postoperative sensory recovery time, first ambulation time, postoperative complications, hospitalization cost, and length of hospital stay were compared between the two groups. t test, χ² test, and Fisher exact probability method were used. Results　The VAS score of the F/I group 6 h after operation was lower than that of the CSEA group [(2.08±0.61) points vs. (2.54±0.64) points], with a statistically significant difference (t=-2.484, P=0.018). The sensory recovery time of the F/I group was longer than that of the CSEA group [(6.25±0.40) h vs. (3.60±0.31) h], and the first ambulation time was shorter than that of the CESA group [(2.99±1.05) h vs. (8.14±1.88) h], with statistically significant differences (t=14.095 and -12.263, both P<0.001). The postoperative complications: the incidence of intraoperative anesthesia in the F/I group was 3.3% (2/60), the incidence of urinary retention was 0, the incidence of lower extremity venous thrombosis was 1.7% (1/60), and the incidence of nausea and vomiting was 3.3% (2/60); in the CSEA group, the incidence of postoperative anesthesia was 0, the incidence of urinary retention was 10.0% (6/60), the incidence of lower extremity venous thrombosis was 5.0% (3/60), and the incidence of nausea and vomiting was 16.7% (10/60); there were statistically significant differences in the incidence of urinary retention and nausea and vomiting between the two groups (both P<0.05). The length of hospital stay and hospitalization cost in the F/I group were (3.90±0.63) d and (9 612.67±507.15) yuan, and those in the CESA group were (5.27±0.75) d and (11 401.52±530.01) yuan, with statistically significant differences (t=-8.862 and -15.425, both P<0.001). Conclusion　Femoral nerve block combined with intra-articular infiltration anesthesia in knee arthroscopic surgery can reduce the postoperative complications, shorten the length of hospital stay, reduce the cost of hospitalization, and provide a good anesthetic effect.

Key words:

Femoral nerve block, Combined spinal-epidural anesthesia, Knee arthroscopy, Intra-articular anaesthesia, Meniscus injury, Surgical complications

林振州刘明廷张成年李健马明亮.

股神经阻滞联合关节腔浸润麻醉在膝关节镜手术中的应用效果 [J]. 国际医药卫生导报, 2024, 30(2): 210-213.

Lin Zhenzhou, Liu Mingting, Zhang Chengnian, Li Jian, Ma Mingliang.

Application effect of femoral nerve block combined with intra-articular anaesthesia in knee arthroscopy [J]. International Medicine and Health Guidance News, 2024, 30(2): 210-213.

参考文献

[1] Dong J, Xu H, Jin G, et al. The adaptive change of patellofemoral joint after arthroscopic discoid lateral meniscus plasty: an observational study[J]. Medicine (Baltimore), 2018, 97(6): e9827. DOI: 10.1097/MD.0000000000009827.
[2] Rai MF, McNulty AL. Meniscus beyond mechanics: using biology to advance our understanding of meniscus injury and treatment[J]. Connect Tissue Res, 2017, 58(3-4): 221-224. DOI: 10.1080/03008207.2017.1312921.
[3] 吴俊涛,张鹏远,李军章,等. 膝关节镜关节清理术联合透明质酸钠治疗髌股关节炎膝前痛临床研究[J]. 国际医药卫生导报,2017,23(1):56-58. DOI:10.3760/cma.j.issn.1007- 1245.2017.01.0018.
[4] 张维国. 关节镜辅助下微创手术治疗胫骨平台骨折患者的效果[J]. 国际医药卫生导报,2021,27(17):2761-2763. DOI:10.3760/cma.j.issn.1007-1245.2021.17.032.
[5] Erivan R, Volkova V, Villatte G, et al. Knee arthroscopy prospective observational study of patient information[J]. Eur J Orthop Surg Traumatol, 2019, 29(7): 1495-1500. DOI: 10.1007/s00590-019-02447-x.
[6] 赵文胜. 不同麻醉方式下关节镜治疗膝骨关节炎临床疗效对比[J]. 基层医学论坛,2018,22(25):3549-3550. DOI:10.19435/j.1672-1721.2018.25.034.
[7] 刘俊,魏丹,池雷霆,等. 持续股神经阻滞对全膝关节置换术后疼痛和功能康复的影响[J]. 中国医刊,2021,56(7):741-744. DOI:10.3969/j.issn.1008-1070.2021.07.014.
[8] 顾志俭,周海军,徐炜. 超声引导下股神经阻滞联合全身麻醉对高龄膝关节镜手术患者镇痛和术后谵妄的影响[J]. 广西医学,2021,43(13):1566-1569. DOI:10.11675/j.issn.0253-4304.2021.13.09.
[9] 徐诚实,王庚. 超声定位神经阻滞在膝关节手术中的应用现状及争议[J]. 临床外科杂志,2019,27(6):453-456. DOI:10.3969/j.issn.1005-6483.2019.06.002.
[10] Barrington MJ, Kluger R. Ultrasound guidance reduces the risk of local anesthetic systemic toxicity following peripheral nerve blockade[J]. Reg Anesth Pain Med, 2013, 38(4): 289-299. DOI: 10.1097/AAP.0b013e318292669b.
[11] Hadzic A, Karaca PE, Hobeika P, et al. Peripheral nerve blocks result in superior recovery profile compared with general anesthesia in outpatient knee arthroscopy[J]. Anesth Analg, 2005, 100(4): 976-981. DOI: 10.1213/01.ANE.0000150944.95158.B9.
[12] Cuvillon P, Nouvellon E, Marchand P, et al. Triple nerve block for ambulatory knee arthroscopy[J]. Ann Fr Anesth Reanim, 2010, 29(10): 710-715. DOI: 10.1016/j.annfar.2010.06.023.
[13] Davarci I, Tuzcu K, Karcioglu M, et al. Comparison between ultrasound-guided sciatic-femoral nerve block and unilateral spinal anaesthesia for outpatient knee arthroscopy[J]. J Int Med Res, 2013, 41(5): 1639-1647. DOI: 10.1177/0300060513498671.
[14] Muraskin SI, Conrad B, Zheng N, et al. Falls associated with lower-extremity-nerve blocks: a pilot investigation of mechanisms[J]. Reg Anesth Pain Med, 2007, 32(1): 67-72. DOI: 10.1016/j.rapm.2006.08.013.
[15] 邱贵兴,戴尅戎,杨庆铭,等. 预防骨科大手术后深静脉血栓形成的专家建议--深静脉血栓形成预防座谈会纪要[J]. 中华骨科杂志,2005,25(10):636-640. DOI:10.3760/j.issn:0253-2352.2005.10.018.
[16] 张琴,韩志强,钟海燕. 超声联合神经刺激仪引导下周围神经阻滞的安全性及有效性进展[J]. 河北医药,2017,39(5):757-759. DOI:10.3969/j.issn.1002-7386.2017.05.034.
[17] 卢仑,张冯江,高肖波,等. 股神经-坐骨神经联合阻滞与硬膜外阻滞对膝关节镜手术患者麻醉效果的影响[J]. 浙江创伤外科,2017,22(2):387-389. DOI:10.3969/j.issn.1009- 7147.2017.02.087.
[18] 孔宪刚,李成文,侯代亮. 超声引导下股神经联合侧入路腘窝坐骨神经阻滞用于膝关节镜手术麻醉效果观察[J]. 山东医药,2015(48):55-57. DOI:10.3969/j.issn.1002- 266X.2015.48.020.
[19] Fowler SJ, Symons J, Sabato S, et al. Epidural analgesia compared with peripheral nerve blockade after major knee surgery: a systematic review and meta-analysis of randomized trials[J]. Br J Anaesth, 2008, 100(2):154-164. DOI: 10.1093/bja/aem373.