de Lima E Souza Rodrigo, Correa Cláudio Henrique, Henriques Maurício Delage, de Oliveira Christiano Barbosa, Nunes Tarcizo Afonso, Gomez Renato Santiago
Department of Surgery, Faculty of Medicine, Federal University of Minas Gerais, Minas Gerais, Brazil.
J Clin Anesth. 2008 Nov;20(7):521-7. doi: 10.1016/j.jclinane.2008.05.016. Epub 2008 Nov 18.
To investigate the effects of single-injection femoral nerve block (FNB) in postoperative pain after total knee replacement (TKR) and anterior cruciate ligament (ACL) reconstruction.
Prospective, randomized, double-blind study.
96 ASA physical status I, II, and III patients, scheduled for TKR or ACL reconstruction.
All patients received a standard spinal anesthetic, then were randomly divided into three treatment groups as follows: Group B (n = 30) received an FNB with 40 mL of 0.25% bupivacaine containing epinephrine, 1:200,000; Group R (n = 32) received an FNB with 40 mL of 0.25% ropivacaine; and Group C (n = 28) received no FNB.
The following clinical outcomes were assessed at up to 6 hours (T1), 6 to 10 hours (T2), and 10 to 24 hours (T3) after spinal anesthesia was given: visual analog scale (VAS) for pain, both at rest and on movement (no or mild pain, moderate pain, or severe pain); morphine use; sensory block in the femoral, obturator, and lateral femoral cutaneous nerve dermatomes; and motor block of the femoral and obturator nerves.
Except for VAS during rest and on movement at time T3, there were more Group C patients who experienced moderate or severe pain than those who had no pain or mild pain, when compared with Groups R and B. Sensory block in the femoral and lateral femoral cutaneous nerve dermatomes did not differ between Groups R and B at any times. However, sensory block in the obturator nerve dermatome was lower in Group R than Group B only at T3. We observed a lower, significant use of morphine at T2 when comparing Groups R and B with Group C. No Group R patient and about 30% of Group B patients remained with motor block of femoral and obturator nerves at T3. Except for frequency of nausea, which was highest in Group C, the frequency of other side effects was similar among the three groups.
Femoral nerve block using 0.25% ropivacaine or 0.25% bupivacaine is an effective method of postoperative analgesia after TKR and ACL reconstruction, particularly for the first 10 hours after spinal anesthesia.
探讨单次注射股神经阻滞（FNB）对全膝关节置换术（TKR）和前交叉韧带（ACL）重建术后疼痛的影响。
前瞻性、随机、双盲研究。
96例ASA身体状况为I、II和III级，计划行TKR或ACL重建的患者。
所有患者均接受标准的脊髓麻醉，然后随机分为三个治疗组，如下：B组（n = 30）接受含肾上腺素1:200,000的40 mL 0.25%布比卡因进行股神经阻滞；R组（n = 32）接受40 mL 0.25%罗哌卡因进行股神经阻滞；C组（n = 28）未接受股神经阻滞。
在给予脊髓麻醉后长达6小时（T1）、6至10小时（T2）和10至24小时（T3）评估以下临床结局：静息和活动时的视觉模拟疼痛评分（VAS）（无痛或轻度疼痛、中度疼痛或重度疼痛）；吗啡用量；股神经、闭孔神经和股外侧皮神经皮节的感觉阻滞；以及股神经和闭孔神经的运动阻滞。
与R组和B组相比，除T3时静息和活动时的VAS外，C组经历中度或重度疼痛的患者多于无痛或轻度疼痛的患者。R组和B组在任何时候股神经和股外侧皮神经皮节的感觉阻滞均无差异。然而，仅在T3时，R组闭孔神经皮节的感觉阻滞低于B组。与C组相比，在T2时R组和B组吗啡用量显著较低。在T3时，R组无患者，B组约30%的患者仍存在股神经和闭孔神经的运动阻滞。除C组恶心发生率最高外，三组其他副作用的发生率相似。
使用0.25%罗哌卡因或0.25%布比卡因进行股神经阻滞是TKR和ACL重建术后有效的镇痛方法，尤其是在脊髓麻醉后的前10小时。
