罗哌卡因关节腔内注射与股神经阻滞用于膝关节镜检术后疼痛治疗效果的比较

【】　目的　比较单次股神经阻滞和关节腔内单次注射罗哌卡因对膝关节镜检术后镇痛效果，为临床应用提供试验依据。　方法　2009年1月-2010年7月，选择美国麻醉医师协会（ASA）Ⅰ～Ⅱ级、年龄18~65岁、拟行择期单侧下肢膝关节镜手术患者180例，随机分为股神经阻滞组和关节腔内用药组，每组90例，分别于术前1h行股神经阻滞（0.15%罗哌卡因20mL）和手术结束时在膝关节腔内注入0.6%罗哌卡因20mL。于术后4、8、24h采用视觉模拟评分法（visualanalogscale，VAS）行静止和运动时疼痛评分，记录术后患者满意度、不良反应发生率，术后使用镇痛药物情况。　结果　关节腔内用药组术后镇痛药物使用率（41.11%）明显高于股神经阻滞组（20.00%）（P0.05）。　结论　股神经阻滞可提供更加有效的术后镇痛效果，并且用药量小，安全系数高，值得临床推广。【Abstract】　Objective　Tocomparetheeffectofsingle-injectionfemoralnerveblockandlocalanestheticintraarticularinjectionforanalgesiaafterkneearthroscopy,inordertoprovidetheexperimentalbaseforclinicalapplication.　Methods　FromJanuary2009toJuly2010,180AmericanSocietyofAnesthesiologists(ASA)physicalstatusI-IIpatients,agedfrom18to65yearsold,andscheduledforelectivesinglekneearthroscopywererandomlydividedintotwogroupsfemoralnerveblockgroupandlocalanestheticintraarticularinjectiongroupwith90patientsineachgroup.Forthepatientsintheformergroup,20mLof0.15%ropivacainewasinjected1hourbeforeoperation.Forthelattergroup,20mLof0.6%ropivacainewasinjectedintothearticularcavityafteroperation.Painintensionscoresatrestandinmotionweremeasured4,8,and24hoursafteroperationbyvisualanalogscale(VAS).Thedegreeofpatients’satisfaction,adversereactionincidencerateandinformationoftakingpain-killerswerealsorecorded.　Results　Therateofusingpain-killersintheintraarticularinjectiongroup(41.11%)wasdramaticallyhigherthanthefemoralnerveblockgroup(20.00%)(P<0.005).TheVASscoresofpatientsintheintraarticularinjectiongroupatrest24hoursafteroperationandinmotion8hoursand24hoursafteroperationweresignificantlyhigherthanthefemoralnerveblockgroup(P<0.001),whiletherewasnosignificantdifferenceatotherpointsbetweenthetwogroups.　Conclusions　Femoralnerveblockismoreefficientforanalgesiaafterkneearthroscopycomparedwithlocalanestheticintraarticularinjection.Itisasafeprocedurerequiringonlyarelativelysmalldoseofmedicine,andisworthbeingpopularized.