【摘要】 目的 比較單次股神經阻滯和關節腔內單次注射羅哌卡因對膝關節鏡檢術后鎮痛效果，為臨床應用提供試驗依據。 方法 2009年1月-2010年7月，選擇美國麻醉醫師協會（ASA）Ⅰ～Ⅱ級、年齡18~65歲、擬行擇期單側下肢膝關節鏡手術患者180例，隨機分為股神經阻滯組和關節腔內用藥組，每組90例，分別于術前1 h行股神經阻滯（0.15%羅哌卡因20 mL）和手術結束時在膝關節腔內注入0.6%羅哌卡因20 mL。于術后4、8、24 h采用視覺模擬評分法（visual analog scale，VAS）行靜止和運動時疼痛評分，記錄術后患者滿意度、不良反應發生率，術后使用鎮痛藥物情況。 結果 關節腔內用藥組術后鎮痛藥物使用率（41.11%）明顯高于股神經阻滯組（20.00%）（P lt;0.005）。兩組患者術后24 h靜止時及術后8、24 h運動時的VAS評分關節腔內用藥組均明顯高于股神經阻滯組（P lt;0.001），其余各時點差異無統計學意義（P gt;0.05）。 結論 股神經阻滯可提供更加有效的術后鎮痛效果，并且用藥量小，安全系數高，值得臨床推廣。
【Abstract】 Objective To compare the effect of single-injection femoral nerve block and local anesthetic intraarticular injection for analgesia after knee arthroscopy, in order to provide the experimental base for clinical application. Methods From January 2009 to July 2010, 180 American Society of Anesthesiologists (ASA) physical status I-II patients, aged from 18 to 65 years old, and scheduled for elective single knee arthroscopy were randomly divided into two groups: femoral nerve block group and local anesthetic intraarticular injection group with 90 patients in each group. For the patients in the former group, 20 mL of 0.15% ropivacaine was injected 1 hour before operation. For the latter group, 20 mL of 0.6% ropivacaine was injected into the articular cavity after operation. Pain intension scores at rest and in motion were measured 4, 8, and 24 hours after operation by visual analog scale (VAS). The degree of patients’ satisfaction, adverse reaction incidence rate and information of taking pain-killers were also recorded. Results The rate of using pain-killers in the intraarticular injection group (41.11%) was dramatically higher than the femoral nerve block group (20.00%) (P lt;0.005). The VAS scores of patients in the intraarticular injection group at rest 24 hours after operation and in motion 8 hours and 24 hours after operation were significantly higher than the femoral nerve block group (P lt;0.001), while there was no significant difference at other points between the two groups. Conclusions Femoral nerve block is more efficient for analgesia after knee arthroscopy compared with local anesthetic intraarticular injection. It is a safe procedure requiring only a relatively small dose of medicine, and is worth being popularized.
Citation： SU Li,WU Wenzhi,YAN Yalan,YANG Guang,ZHANG Lan. Comparison of the Effect of Ropivacaine Intraarticular Injection and Femoral Nerve Block for Analgesia after Knee Arthroscopy. West China Medical Journal, 2011, 26(3): 417-420. doi: Copy
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