不同剂量艾司氯胺酮复合罗哌卡因股神经–坐骨神经阻滞对全麻膝关节置换术后反应性疼痛的影响

宋小倩; 李梦华; 杨露; 王义凯; 刘伟; 李晓明; 解凤磊

不同剂量艾司氯胺酮复合罗哌卡因股神经–坐骨神经阻滞对全麻膝关节置换术后反应性疼痛的影响

The influence of different doses of esketamine combined with ropivacaine femoral-sciatic nerve block on reactive pain after general anesthesia knee arthroplasty

摘要

摘要:
目的： 探讨不同剂量艾司氯胺酮复合罗哌卡因股神经–坐骨神经阻滞对全麻膝关节置换术后反应性疼痛的影响。
方法： 招募99例接受初次膝关节置换术的病人，按1∶1∶1比例随机分配至低剂量组（L组）、高剂量组（H组）和对照组（C组），每组33例。股神经–坐骨神经阻滞L组使用0.25%罗哌卡因 + 0.25 mg/kg艾司氯胺酮30 mL，H组使用0.25%罗哌卡因 + 0.5 mg/kg艾司氯胺酮30 mL，C组仅使用0.25%罗哌卡因30 mL。记录3组术后反应性疼痛发生率、感觉和运动阻滞持续时间、术后48 h内镇痛泵按压次数及阿片类药物消耗量、术后不良反应、首次下床活动时间及术后48 h膝关节主动活动度。
结果： H组反应性疼痛发生率显著低于L组和C组（P ＜ 0.05）。NRS评分在术后6、12、24、48 h组间比较显示，在4个时间点均按照C组、L组、H组顺序呈下降趋势（P ＜ 0.05）。术后48 h内镇痛泵按压次数及阿片类药物消耗量按照C组、L组、H组均呈减少趋势（P ＜ 0.01）；而感觉和运动阻滞持续时间则按照照C组、L组、H组均呈增加趋势（P ＜ 0.01）。3组术后恶心呕吐、低血压、尿潴留和便秘的发生率差异均无统计学意义（P ＞ 0.05）。3组病人首次下床活动时间及术后48 h膝关节主动活动度比较，差异均无统计学意义（P ＞ 0.05）。
结论： 0.5 mg/kg艾司氯胺酮复合罗哌卡因股神经–坐骨神经阻滞可显著减少膝关节置换术术后反应性疼痛发生，强化术后镇痛效果，延长神经阻滞持续时间，安全性良好。

Abstract:
Objective To explore the effect of different doses of esketamine combined with ropivacaine on femoral and sciatic nerve block on reactive pain after knee arthroplasty under general anesthesia.
Methods A total of 99 patients undergoing primary knee arthroplasty were recruited, and randomly divided into the low-dose group (Group L), high-dose group (Group H) and control group (Group C) at 1∶1∶1 ratio to, with 33 cases in each group. In the femoral nerve-sciatic nerve block group (group L), the 0.25% ropivacaine + 0.25 mg/kg esketamine 30 mL was used. In group H, the 0.25% ropivacaine + 0.5 mg/kg esketamine 30 mL was used. In group C, only 0.25% ropivacaine 30 mL was used. The incidence of reactive pain after surgery, duration of sensory and motor block, number of compressions of the analgesic pump and Opioid consumption within 48h after operation, postoperative adverse reactions, time of first getting out of bed and active range of motion of the knee joint after 48 hours of surgery were recorded in three groups.
Results The incidence of reactive pain in group H was significantly lower than that in group L and group C (P ＜ 0.05). The comparison of NRS scores among three groups after 6, 12, 24 and 48 hours of operation showed that at each of the four time points, the scores decreased in the order of group C, Group L, and Group h (P ＜ 0.05). The number of compressions of the analgesic pump and consumption of opioid drugs within 48 hours after the operation showed a decreasing trend in group C, Group L and Group H (P ＜ 0.01). The duration of sensory and motor block showed an increasing trend in group C, Group L and Group H (P ＜ 0.01). There was no statistically significant difference in the incidence of postoperative nausea and vomiting, hypotension, urinary retention and constipation among three groups (P ＞ 0.05). There was no statistically significant difference in the time of first getting out of bed and active range of motion of the knee joint after 48 hours of surgery among the three groups (P ＞ 0.05).
Conclusions The 0.5 mg/kg esketamine combined with ropivacaine femoral-sciatic nerve block can significantly reduce the occurrence of reactive pain after knee arthroplasty, enhance the postoperative analgesic effect, prolong the duration of nerve block, and has good safety.

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