超声或神经刺激仪辅助股神经阻滞用于膝关节置换术快通道麻醉的观察

摘要：Objective To observe the effects of ultrasound and nerve stimulators in assisting femoral nerve blockage for fast-track anesthesia in total knee arthroplasty (TKA).Methods A total of 60 patients undergoing TKA were randomly divided into three groups (n=20).All the patients performed single femoral nerve blockage.Group Ⅰ was blocked before anesthesia guided by ultrasound.Group Ⅱ was blocked by a nerve stimulator before anesthesia.Group Ⅲ was blocked after awaking guided by ultrasound.All the patients were intravenously injected with 40 mg parecoxib before operation, and exposed to local anesthetics during operation followed by patient-controlled intravenous analgesia (PCIA) after operation using 0.2 μg/kg sufentanil at a rate of 2 ml/h after background doses.Then, the doses of anesthetics used during the operation, awakening time in postanesthesia care unit (PACU) and patient satisfaction on anesthesia were observed.The time to perform femoral nerve blockage and blockage time were recorded.The rest visual analogue scores (RVAS) at 6, 12, 24 and 48 hours after operation, and adverse reactions were recorded.Results Compared with Group Ⅲ, the doses of anesthetics used during operation and awakening time were reduced in Groups Ⅰ and Ⅱ (P<0.05).Group Ⅰ showed improved patient satisfaction on anesthesia, compared with Group Ⅲ (P<0.05).Group I also presented shorter time to perform femoral nerve blockage and blockage time than Group Ⅱ (P<0.05).No statistical difference was found in RVAS at 6, 12 ,24 and 48 hours after operation and adverse reactions among the three groups (P>0.05).Conclusions Single femoral nerve blockage before operation combined with fast-track anesthesia can stimulate the recovery of TKA patients.Compared with nerve stimulators, ultrasound is more beneficial to guide the blockage.