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0.375%罗哌卡因三合一股神经阻滞对老年患者全膝关节置换术后吗啡用量的影响

The effect of 3-in-1 femoral nerve block with ropivacaine 0.375% on postoperative morphine consumption in elderly patients after total knee replacement surgery.

作者信息

Ozen Mehmet, Inan Nurten, Tümer Filiz, Uyar Ahmet, Baltaci Bülent

机构信息

Ministry of Health Ankara Research and Training Hospital, Anesthesiology Department, Ankara, Turkey.

出版信息

Agri. 2006 Oct;18(4):44-50.

Abstract

Total knee replacement (TKR) is one of the most painful orthopedic surgical procedures. This study was aimed to investigate the effect of a single-shot preoperative 3-in-1 femoral nerve block on postoperative pain by using 0.375% ropivacaine, and on the consumption of morphine by using PCA following the TKR surgery. Side effects were also evaluated in this setting. 34 patients were included in this study. Group R (n=17) received a 3-in-1 femoral nerve block (FNB) with 40 mll of ropivacaine 0.375%. Group S (n=17) received only a 2 mg loading dose of morphine 30 minutes before the end of surgery, and no block was performed. Both groups received general anesthesia and postoperatively had a PCA pump programmed to deliver morphine. VAS scores at rest, morphine consumption and adverse effects were recorded. Two patients were excluded from each group. Pain scores at 0, 1, 2, 3, 4, 6, 8 postoperative hours were significantly lower in group R in resting position (p<0.05). Group R experienced no pain at the recovery room and this state lasted 8 hours after the surgery while group S reached the acceptable score (VAS ? 3) one hour after leaving the recovery room. The morphine requirement was significantly lower in Group R at 12, 18, 24, 48 hr after TKR (p<0.001). Side effects were also lower in this group. Preoperative single-shot 3-in-1 FNB with 40 cc of ropivacaine 0.375% provides better VAS scores, less morphine consumption and fewer side effects in elderly patients when compared to the group with no block.

摘要

全膝关节置换术(TKR)是最疼痛的骨科手术之一。本研究旨在探讨术前单次注射0.375%罗哌卡因的三合一股神经阻滞对TKR术后疼痛的影响,以及对术后使用PCA时吗啡消耗量的影响。同时还评估了这种情况下的副作用。本研究纳入了34例患者。R组(n = 17)接受了40毫升0.375%罗哌卡因的三合一股神经阻滞(FNB)。S组(n = 17)仅在手术结束前30分钟接受2毫克吗啡的负荷剂量,未进行阻滞。两组均接受全身麻醉,术后均使用PCA泵输注吗啡。记录静息时的视觉模拟评分(VAS)、吗啡消耗量和不良反应。每组各排除2例患者。术后0、1、2、3、4、6、8小时,R组静息位的疼痛评分显著更低(p<0.05)。R组在恢复室无疼痛,这种状态持续至术后8小时,而S组在离开恢复室1小时后达到可接受评分(VAS≤3)。TKR术后12、18、24、48小时,R组的吗啡需求量显著更低(p<0.001)。该组的副作用也更少。与未阻滞组相比,术前单次注射40毫升0.375%罗哌卡因的三合一FNB在老年患者中可提供更好的VAS评分、更少的吗啡消耗量和更少的副作用。

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