Orthopaedic Surgery, Sakakibara Spa Hospital, Sakakibara Town, 1033-4, Tsu, Mie, 514-1293, Japan.
J Anesth. 2013 Feb;27(1):132-4. doi: 10.1007/s00540-012-1479-2. Epub 2012 Sep 6.
Ambulation in the early postoperative period of total knee arthroplasty is crucial, in order to avoid complications and obtain preferable outcomes. Although a femoral nerve block can provide enough postoperative analgesia after total knee arthroplasty, falling, or other accidents due to motor paresis, are potentially adverse events in patients who have received a conventional femoral nerve block. We devised a modified femoral nerve block to spare voluntary knee extension ability, and clinically applied it to patients who received total knee arthroplasty under minimally invasive surgery. In our new-approach nerve blockade technique, the main targets of the sensory nerves are the saphenous nerves which branch out from the femoral nerve trunk. All the patients rated pain at bed rest between 0 and 3 on a numerical rating scale 3 h after the operation. In addition, the rectus femoris muscle was not affected at all, and the surgically invaded vastus medialis oblique muscle was completely anesthetized. Patients were able to not only actively raise their extremities with their knee in extension, but also to flex the knee in the air without pain or aggravation. On day 0, the patients were able to walk around, with the leg that had been operated upon not giving way. Our anesthetic approach can provide better pain relief than a conventional femoral nerve block, while the patients achieve ambulation on the day of the procedure, following minimally invasive knee surgery.
全膝关节置换术后早期活动至关重要，以避免并发症并获得更好的结果。虽然股神经阻滞在全膝关节置换术后可以提供足够的术后镇痛，但由于运动麻痹，患者可能会发生跌倒或其他意外，这是接受常规股神经阻滞的潜在不良事件。我们设计了一种改良的股神经阻滞，以保留膝关节主动伸展能力，并将其临床应用于微创膝关节置换术患者。在我们的新方法神经阻滞技术中，感觉神经的主要目标是从股神经干分支出来的隐神经。所有患者在术后 3 小时内的卧床休息时疼痛评分均在 0 到 3 之间（数字评分量表）。此外，股直肌完全不受影响，并且手术侵犯的股内斜肌完全被麻醉。患者不仅可以主动伸直腿部，还可以在空中弯曲膝盖而不会感到疼痛或加重。在第 0 天，患者可以走动，手术的腿不会发软。我们的麻醉方法可以提供比常规股神经阻滞更好的镇痛效果，同时患者可以在微创膝关节手术后当天进行活动。
