| 李宗原,石波,唐诗添,等.超声引导下隐神经阻滞联合帕瑞昔布用于胫骨高位截骨术后精准镇痛的临床应用研究.骨科,2022,13(3): 243-248. |
| 超声引导下隐神经阻滞联合帕瑞昔布用于胫骨高位截骨术后精准镇痛的临床应用研究 |
| Clinical Application of Ultrasound-Guided Saphenous Nerve Block Combined with Parecoxib for Precise Analgesia Following High Tibial Osteotomy |
| 投稿时间：2021-11-20 |
| DOI：10.3969/j.issn.1674-8573.2022.03.010 |
| 中文关键词: 超声 神经阻滞 帕瑞昔布 截骨术 镇痛 |
| 英文关键词: Ultrasonic Nerve block Parecoxib Osteotomy Analgesia |
| 基金项目:四川省医学会骨科（尚安通）专项科研课题（2019SAT25） |
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| 中文摘要: |
| 目的 探讨超声引导下隐神经阻滞联合帕瑞昔布用于胫骨高位截骨术后镇痛的临床疗效。方法 选取2020年1月至2021年3月于我院行胫骨高位截骨手术的病人，按照时间顺序进行分组研究，将病人分为三组：2020年1月至2020年5月超声引导隐神经阻滞（罗哌卡因）联合术后静脉注射帕瑞昔布者纳入A组；2020年6月至2020年10月超声引导隐神经阻滞（罗哌卡因）联合术后静脉镇痛泵（舒芬太尼）者纳入B组；2020年11月至2021年3月术后静脉镇痛泵（舒芬太尼）者纳入C组。统计分析三组病人疼痛、功能、并发症方面的差异。结果 静息状态下，术后4 h、12 h，A组疼痛视觉模拟量表（visual analogue scale，VAS）评分均明显低于B组和C组；术后4 h、12 h、24 h，A组、B组VAS评分均明显低于C组；术后48 h、6 d，A组明显低于C组，差异有统计学意义（P＜0.05）。屈曲45°活动状态下，术后4 h、12 h、24 h、48 h，A组和B组的VAS评分均明显低于C组；术后6 d，A组明显低于B组和C组，差异均有统计学意义（P均＜0.05）。术后24 h、48 h，A组膝关节功能Lysholm评分优于B组和C组；术后6 d，A组优于C组；术后24 h时，B组优于C组，差异均有统计学意义（P＜0.05）。术后1、3、6个月，三组病人在静息状态、活动状态的VAS评分及膝关节功能Lysholm评分方面的差异均无统计学意义（P＞0.05）。术后3 d，A组术后镇痛满意度优于B组和C组，B组优于C组，差异有统计学意义（P＜0.05）；术后6 d，A组和B组优于C组，差异有统计学意义（P＜0.05）。A组术后住院时间短于C组，差异有统计学意义（P＜0.05）。三组并发症的差异无统计学意义（P＞0.05）。结论 超声引导下隐神经阻滞可以提高阻滞的成功率，降低穿刺相关性并发症，可重复性强。通过超声引导下隐神经阻滞联合帕瑞昔布的镇痛方案可改善手术后病人的不愉快体验，显著减轻病人术后疼痛，实现快速康复，减少镇痛泵的使用，符合精准医疗理念，操作较简单，便于推广。 |
| 英文摘要: |
| Objective To investigate the clinical effect of ultrasound-guided saphenous nerve block combined with parecoxib for postoperative analgesia after high tibial osteotomy. Methods Patients undergoing high tibial osteotomy in our hospital from January 2020 to March 2021 were selected for stratified study in chronological order and divided into 3 groups: group A (January 2020-May 2020), ultrasound-guided saphenous nerve block (ropivacaine) + parecoxib; group B (June 2020-October 2020), ultrasound-guided saphenous nerve block (ropivacaine) + patient-controlled analgesia pump (sufentanil); group C (November 2020 to March 2021), patient-controlled analgesia pump (sufentanil). The differences in pain, function and complications among the three groups were statistically analyzed. Results At rest, visual analogue scale (VAS) scores in group A were significantly lower than those in group B and group C at 4 h and 12 h after surgery, those in group A and group B were significantly lower than those in group C at 4 h, 12 h, and 24 h after surgery, and those in group A was significantly lower than those in group C at 48 h and 6 d after operation. There was statistically significant difference (P＜0.05). At 45° flexion activity, VAS scores in group A and group B were significantly lower than those in group C at 4 h, 12 h, 24 h and 48 h after surgery, and those in group A were significantly lower than those in group B and group C at the 6 d after surgery. There was statistically significant difference (P＜0.05). The Lysholm score in group A was better than that in group B and group C at 24 h and 48 h after surgery. Lysholm score in group A was better than that in group C at the 6 d after surgery. Lysholm score in group B was superior to that in group C at 24 h after surgery (P＜0.05). There was no statistically significant difference in VAS score at resting state, activity state and Lysholm score of knee function in patients at 1st, 3rd and 6th month after surgery. The analgesia satisfaction in group A at 3rd day postoperatively was superior to group B and group C, and that in group B was superior to group C (P＜0.05), and that in group A and group B at the 6th d postoperatively was superior to group C (P＜0.05). The length of postoperative hospital stay in group A was shorter than that in group C (P＜0.05). There was no significant difference in complications among the three groups (P＞0.05). Conclusion Ultrasound-guided saphenous nerve block can improve the success rate of block, reduce puncture related complications, and has strong repeatability. This analgesic solution of ultrasonic-guided saphenous nerve block combined with parecoxib can improve the unpleasant experience of patients after surgery, significantly reduce postoperative pain, achieve rapid recovery and reduce the use of analgesic pump, and conforms to the concept of precision medicine, with simple operation and easy to be popularized. |
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