关节镜下前交叉韧带重建术中内收肌管阻滞与腘绳肌周围浸润联合内收肌道阻滞术后镇痛的比较

Q4 Medicine
Suman Saini , Neha Khattar , Divya Gautam , Nidhi Agrawal , Anju Gupta
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引用次数: 2

摘要

背景:前交叉韧带重建(ACLR)后的疼痛可归因于关节镜手术和移植物供体部位。常规使用的周围神经阻滞技术可能不能对移植物供体部位提供完全的镇痛。此外,股神经阻滞已知会导致股四头肌力量不足。本研究的目的是评估在内收管阻滞中加入腘绳肌周围浸润是否能比单独阻滞更好地实现术后镇痛。方法:60 ASA I级;将拟行蛛网膜下腔阻滞下同侧腘绳肌腱自体移植物重建前交叉韧带的患者随机分为2组,术后分别行单独内收肌管阻滞(A组)和腘绳肌腱周围浸润联合内收肌管阻滞(AH组)。两组均采用0.5%罗哌卡因15 ml配1:20万肾上腺素阻断内收管。AH组患者在腘绳肌供体部位加用0.5%罗哌卡因20 ml,肾上腺素1:20万。记录术后不同时间间隔的疼痛视觉模拟评分(VAS)、首次救援镇痛需求时间、24 h内累积镇痛需求、股四头肌力量、不良反应及患者满意度。结果两组VAS评分(静息&在8和12 h时,两组均观察到动态)(p值<0.001)。AH组首次抢救镇痛时间(11.47±2.92hrs)较A组(8.13±1.28hrs)更长。累积酮酸需要量AH组(34±18.86 mg)低于A组(49±20.06 mg)。两组的股四头肌强度相当,两组均未观察到重大并发症。然而,用数字评定量表(NRS)测量的患者满意度在AH组要好得多。结论局部麻醉在腘绳肌周围浸润联合内收管阻滞比单纯内收管阻滞能更好地缓解自体腘绳肌移植术后疼痛。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Comparison of combined adductor canal block with peri-hamstring infiltration versus adductor canal block for postoperative analgesia in arthroscopic anterior cruciate ligament reconstruction surgery

Background

Pain after anterior cruciate ligament reconstruction (ACLR) can be attributed to both arthroscopic surgery and graft - donor site. Conventionally used techniques of peripheral nerve blockade may not provide complete analgesia to graft - donor site. Moreover, femoral nerve blockade is known to cause quadriceps strength deficit. The purpose of this study was to evaluate whether addition of peri-hamstring infiltration to adductor canal block can lead to better analgesia after surgery than block alone.

Methods

60 ASA grade I & II patients scheduled for anterior cruciate ligament reconstruction surgery using ipsilateral hamstring autograft under subarachnoid block were randomly distributed into 2 groups to receive postoperatively either adductor canal block alone (group A) or peri-hamstring infiltration along with adductor canal block (group AH). Adductor canal block was given in both the groups using 15 ml of 0.5% ropivacaine with 1:200000 adrenaline. Patients in Group AH received additional 20 ml 0.5% ropivacaine with 1:200000 adrenaline at hamstring donor site. Postoperative pain on Visual Analogue Score (VAS) at various time intervals, time to first rescue analgesic requirement, cumulative analgesic requirement over 24 h, quadriceps strength, adverse effects and patient satisfaction were recorded.

Results

Statistically significant difference in mean VAS score (resting & dynamic) was observed in both the groups at 8 and 12 h (p value < 0.001). Time to first rescue analgesic was longer in group AH (11.47 ± 2.92hrs) compared to group A (8.13 ± 1.28hrs). Cumulative ketorolac requirement was lower in group AH (34 ± 18.86 mg) in contrast to group A (49 ± 20.06 mg). Quadriceps strength was comparable in both the groups and no major complications were observed in either group. However, patient satisfaction measured by Numeric Rating Scale (NRS) was much better in group AH.

Conclusion

Peri-Hamstring infiltration of local anaesthetic along with adductor canal block is better than adductor canal block alone at allaying postoperative pain due to hamstring autograft.

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来源期刊
Journal of Arthroscopy and Joint Surgery
Journal of Arthroscopy and Joint Surgery Medicine-Orthopedics and Sports Medicine
CiteScore
0.60
自引率
0.00%
发文量
1
期刊介绍: Journal of Arthroscopy and Joint Surgery (JAJS) is committed to bring forth scientific manuscripts in the form of original research articles, current concept reviews, meta-analyses, case reports and letters to the editor. The focus of the Journal is to present wide-ranging, multi-disciplinary perspectives on the problems of the joints that are amenable with Arthroscopy and Arthroplasty. Though Arthroscopy and Arthroplasty entail surgical procedures, the Journal shall not restrict itself to these purely surgical procedures and will also encompass pharmacological, rehabilitative and physical measures that can prevent or postpone the execution of a surgical procedure. The Journal will also publish scientific research related to tissues other than joints that would ultimately have an effect on the joint function.
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