YaDeau Jacques T, Cahill Janet B, Zawadsky Mark W, Sharrock Nigel E, Bottner Friedrich, Morelli Christine M, Kahn Richard L, Sculco Thomas P
Departments of *Anesthesia, †Rehabilitation, and ‡Orthopaedic Surgery, Hospital for Special Surgery, Weill Medical College of Cornell University, New York, New York.
Anesth Analg. 2005 Sep;101(3):891-895. doi: 10.1213/01.ANE.0000159150.79908.21.
Either epidural analgesia or femoral nerve blockade improves analgesia and rehabilitation after total knee arthroplasty. No study has evaluated the combination of femoral nerve blockade and epidural analgesia. In this prospective, randomized, blinded study we investigated combining femoral nerve blockade with epidural analgesia. Forty-one patients received a single-injection femoral nerve block with 0.375% bupivacaine and 5 microg/mL epinephrine; 39 patients served as controls. All patients received combined spinal-epidural anesthesia and patient-controlled epidural analgesia with 0.06% bupivacaine and 10 microg/mL hydromorphone. Average duration of epidural analgesia was 2 days. All patients received the same standardized physical therapy intervention. Median visual analog scale (VAS) scores with physical therapy were significantly lower for 2 days among patients who received a femoral nerve block versus controls: 3 versus 4 (day 1), 2.5 versus 4 (day 2); P < 0.05. Median VAS pain scores at rest were 0 in both groups on days 1 and 2. Flexion range of motion was improved on postoperative day 2 (70 degrees versus 63 degrees ; P < 0.05). No peripheral neuropathies occurred. We conclude that the addition of femoral nerve blockade to epidural analgesia significantly improved analgesia for the first 2 days after total knee arthroplasty.
硬膜外镇痛或股神经阻滞均可改善全膝关节置换术后的镇痛效果及康复情况。尚无研究评估股神经阻滞与硬膜外镇痛联合应用的效果。在这项前瞻性、随机、双盲研究中，我们对股神经阻滞与硬膜外镇痛联合应用进行了研究。41例患者接受了0.375%布比卡因和5微克/毫升肾上腺素的单次注射股神经阻滞；39例患者作为对照组。所有患者均接受腰麻-硬膜外联合麻醉及0.06%布比卡因和10微克/毫升氢吗啡酮的患者自控硬膜外镇痛。硬膜外镇痛的平均持续时间为2天。所有患者均接受相同的标准化物理治疗干预。在接受股神经阻滞的患者中，术后2天物理治疗时的视觉模拟评分（VAS）中位数显著低于对照组：第1天为3分对4分，第2天为2.5分对4分；P<0.05。两组患者术后第1天和第2天静息时的VAS疼痛评分中位数均为0。术后第2天的屈曲活动范围有所改善（70度对63度；P<0.05）。未发生周围神经病变。我们得出结论，在硬膜外镇痛基础上加用股神经阻滞可显著改善全膝关节置换术后头2天的镇痛效果。
