摘要目的:评价超声引导下收肌管入路一针四点法神经阻滞用于全膝关节置换术后镇痛的效果。方法:择期全麻下单侧全膝关节置换术患者60例，性别不限，年龄65～80岁，BMI 18～27 kg/m 2，ASA分级Ⅱ或Ⅲ级，术后在超声引导下行外周神经阻滞镇痛。按随机数字表法分为2组( n＝30)：收肌管联合后入路坐骨神经阻滞组(ASB组)和收肌管入路一针四点法阻滞坐骨神经、股内侧肌支、隐神经及股前皮神经组(ANSB组)。术后运动时VAS评分≥4分，静脉注射酮咯酸丁三醇0.6 mg/kg补救镇痛。术后2、8、24和48 h时记录患侧股四头肌肌力、膝关节活动度和助行器辅助行走10 m完成情况，记录术后48 h内补救镇痛药物用量、操作完成时间、住院时间和患者满意度评分。 结果:与ASB组比较，ANSB组酮咯酸氨丁三醇用量减少，操作完成时间和住院时间缩短，患者满意度评分升高，术后12、24、36和48 h时膝关节活动度和行走10 m完成率升高( P<0.05)，各时点患侧股四头肌肌力比较差异无统计学意义( P>0.05)。 结论:超声引导下收肌管入路一针四点法神经阻滞用于全膝关节置换术后镇痛效果优于收肌管联合后入路坐骨神经阻滞。

abstractsObjective:To evaluate the efficacy of ultrasound-guided adductor canal approach to nerve block using one-puncture four-point technique for analgesia after total knee arthroplasty (TKA).Methods:Sixty patients of both sexes, aged 65-80 yr, with body mass index of 18-27 kg/m 2, of American Society of Anesthesiologists physical status Ⅱor Ⅲ, scheduled for elective unilateral TKA under general anesthesia, were enrolled in this study.Peripheral nerve block was performed for postoperative analgesia under ultrasound guidance.All the patients were allocated into 2 groups ( n=30 each) using a random number table method: adductor canal block combined with posterior approach to sciatic nerve block group (group ASB) and adductor canal approach to nerve block using one-puncture four-point technique including sciatic nerve, medial vastus muscle nerve, saphenous nerve, anterior femoral cutaneous nerve at adductor canal level group (group ANSB). When visual analogue scale score ≥4 during postoperative movement, ketorolac tromethamine 0.6 mg/kg was intravenously injected as rescue analgesic. The muscle strength of quadriceps on the affected side, range of knee joint motion and rate of the ability to walk for 10 m using the walker were recorded at 2, 8, 24 and 48 h after surgery.The consumption of analgesics for rescue analgesia, manipulation completion time, length of hospital stay and patients′ satisfaction score were recorded within 48 h after surgery. Results:Compared with group ASB, the consumption of ketorolac tromethamine was significantly reduced, manipulation completion time and length of hospital stay were shortened, patients′ satisfaction scores were increased, and the range of knee joint motion and rate of the ability to walk for 10 m using the walker were increased at 2, 8, 24 and 48 h after surgery in group ANSB ( P<0.05). There was no significant difference in muscle strength of quadriceps between two groups ( P>0.05). Conclusion:Ultrasound-guided adductor canal approach to nerve block using one-puncture four-point technique provides better efficacy than adductor canal block combined with posterior approach to sciatic nerve block when used for analgesia after TKA.