对非甾体抗炎药(NSAIDs)副作用敏感的患者在全膝关节置换术中实施低浓度坐骨神经阻滞:一项随机对照试验

2021-11-30 17:36

对于非甾体抗炎药副作用敏感的患者，低浓度SNB和地塞米松关节周围浸润是TKAs术后早期疼痛控制(尤其是运动时)的有效辅助技术，且不会对运动功能造成影响。

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对非甾体抗炎药(NSAIDs)副作用敏感的患者在全膝关节置换术中实施低浓度坐骨神经阻滞:一项随机对照试验

贵州医科大学麻醉与心脏电生理课题组

翻译：张中伟编辑：潘志军审校：曹莹

背景

本研究的目的是比较在全膝关节置换术(TKA)中，内收肌管阻滞、低浓度腘-坐骨神经阻滞(SNB)和关节周围注射地塞米松作为术中辅助镇痛技术对非甾体抗炎药副作用敏感的患者的作用效果。

方法

本研究为一项前瞻性、双盲、随机对照试验，在接受单侧全膝关节置换术的50名对非甾体抗炎药副作用敏感的患者中进行。所有患者均接受椎管内麻醉、内收肌管阻滞和关节周围浸润。干预组的25名患者接受SNB (0.125%布比卡因[20 ml]和地塞米松[5 mg])。

结果

SNB组在第6、12和18小时的静息疼痛评分明显较低:对照组为1(0–4.5)、3(0–5)和3(2–5)；SNB组为0(0–0)、0(0–3)和1(0–3)；p值分别为0.012、0.021和0.010。6、12和18小时的运动疼痛评分也较低:对照组为3(0–5.5)、5(2.5–6.5)和7(4–9)；SNB组为0(0–1.5)、2(0–4)和3(2–5)；p值分别为0.019、0.005和0.001。两组运动功能无差异。此外，SNB组24小时内的平均吗啡消耗量也相对减少:对照组为3.80±2.48mg；SNB组为1.96±2mg；p值为0.005。

结论

原始文献来源

Busara Sirivanasandha , Kulwadee Sutthivaiyakit , Thippatai Kerdchan, et al. Adding a low-concentration sciatic nerve block to total knee arthroplasty in patients susceptible to the adverse effects of nonsteroidal anti-inflammatory drugs (NSAIDs): a randomized controlled trial.[J]. BMC Anesthesiol (2021) 21:282:1

英文原文

Adding a low-concentration sciatic nerve

block to total knee arthroplasty in patients susceptible to the adverse effects of non-steroidal anti-inflammatory drugs (NSAIDs): a randomized controlled trial

Abstract

Background: This study compared the effects of adductor canal blocks with those of a low concentration of popliteal-sciatic nerve block (SNB) and dexamethasone as an adjunctive technique for total knee arthroplasties (TKA)

in patients susceptible to the adverse effects of NSAIDs.

Methods: A prospective, double-blinded, randomized controlled trial was performed in 50 patients susceptible to the adverse effects of NSAIDs undergoing unilateral TKAs. All patients received spinal anesthesia, adductor canal blocks, and periarticular infiltration. The 25 patients in the intervention group received SNB (0.125% bupivacaine [20 ml] and dexamethasone [5 mg]).

Results: The SNB group significantly had lower median resting pain scores at 6, 12, and 18 h: the control group, 1 (0–4.5), 3 (0–5), and 3 (2–5); the intervention group, 0 (0–0), 0 (0–3), and 1 (0–3); p-values, 0.012, 0.021, and 0.010, respectively. Movement-evoked pain scores at 6, 12, and 18 h were also lower: control group, 3 (0–5.5), 5 (2.5–6.5), and 7 (4–9); intervention group, 0 (0–1.5), 2 (0–4), and 3 (2–5); p-values, 0.019, 0.005, and 0.001, respectively. There were no differences in motor function. Moreover, the mean morphine consumption 24 h was also reduced in the SNB group: control group, 3.80±2.48 mg; intervention group, 1.96±2 mg; p-value, 0.005.

Conclusion: For patients susceptible to the adverse effects of NSAIDs, a low concentration of SNB and dexamethasone is an effective adjunctive technique for early postoperative pain control (especially on movement) following TKAs, without an increase in motor weakness.