收肌管阻滞联合腘丛神经阻滞在关节镜下韧带重建术中的应用

doi:10.3969/j.issn.1006-5725.2025.11.008

Abstract

Abstract:

Objective To investigate the impact of adductor canal block （ACB） in combination with popliteal plexus block （PPB） on patients undergoing arthroscopic anterior cruciate ligament reconstruction （ACLR）. Methods Patients who underwent primary unilateral ACLR treatment at our hospital between March 2022 and November 2023 were recruited as the research subjects. They were randomly allocated into the ACB group （n = 43 cases） and the combined PPB group （n = 47 cases） using a coin?toss method. Patients in the ACB group received ACB， while those in the combined PPB group received ACB in conjunction with PPB. The pain intensity， analgesic effect， adverse reactions， and postoperative status following ACLR were compared between the two groups. Results The Visual Analogue Scale （VAS） scores of the combined PPB group were significantly lower than those of the ACB group at 4 hours， 8 hours， 12 hours， 24 hours， and 48 hours post ACLR （P < 0.05）. Repeated measures analysis of variance of VAS scores in the resting and active exercise states of ACLR patients in the two groups revealed that the group effect had F?values of 162.052/142.173 and P?values of 0.000/0.000， the time effect had F?values of 74.223/65.515 and P?values of 0.000/0.000， and the interaction effect had an f?value of 4.707/. The cumulative dose of sufentanil， the frequency of postoperative analgesia， and the proportion of posterior knee pain in the combined PPB group were all lower than those in the ACB group （P < 0.05）. There was no significant difference in adverse reactions between the ACB group and the combined PPB group （P > 0.05）. The hospitalization duration and the time to achieve active straight leg raise in the combined PPB group were shorter than those in the ACB group， while the analgesic satisfaction score was higher than that in the ACB group （P < 0.05）. Conclusion The combination of ACB and PPB in ACLR can effectively alleviate postoperative pain， reduce the requirements for sufentanil and analgesic interventions， enhance patient satisfaction， shorten the hospitalization period and the time to achieve active straight leg raise， and promote early patient recovery without increasing the risk of adverse reactions.

Key words: adductor canal block, popliteal plexus block, reconstruction of anterior cruciate ligament, analgesia, postoperative pain

CLC Number:

R614.3

Guangkai BU,Tao TAO. Application of adductor canal block combined with popliteal plexus block in arthroscopic ligament reconstruction[J]. The Journal of Practical Medicine, 2025, 41(11): 1663-1668.

Figures/Tables 8

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References 30

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组别	例数	性别		年龄（x ± s）/岁	BMI（x ± s）/（kg/m²）	ASA分级			术侧
组别	例数	男	女	年龄（x ± s）/岁	BMI（x ± s）/（kg/m²）	Ⅰ级	Ⅱ级	Ⅲ级	左	右
ACB组	43	30	13	32.54 ± 8.76	22.41 ± 2.03	15	16	12	17	26
联合PPB组	47	32	15	33.02 ± 8.81	22.53 ± 2.10	18	12	17	20	27
χ² /t值		0.030		0.259	0.276	1.532			0.085
P值		0.863		0.796	0.784	0.465			0.771

组别	例数	手术时间/min	术前静息VAS/分	术前屈膝VAS/分
ACB组	43	98.14 ± 11.06	0.62 ± 0.18	2.46 ± 0.76
联合PPB组	47	99.25 ± 11.38	0.63 ± 0.17	2.49 ± 0.78
t值		0.469	0.270	0.185
P值		0.640	0.788	0.854

组别	例数	术后4 h	术后8 h	术后12 h	术后24 h	术后48 h
ACB组	43	2.85 ± 0.38	3.18 ± 0.30^?	3.34 ± 0.32^?#	3.95 ± 0.41^?#△	3.18 ± 0.31^?△▲
联合PPB组	47	2.31 ± 0.36	2.71 ± 0.29^?	2.85 ± 0.35^?#	3.42 ± 0.61^?#△	2.71 ± 0.29^?△▲
t/F值		6.905	6.826	16.052	34.026	18.122
P值		< 0.001	0.011	< 0.001	< 0.001	< 0.001

组别	例数	术后4 h	术后8 h	术后12 h	术后24 h	术后48 h
ACB组	43	3.28 ± 0.34	3.87 ± 0.41^*	3.98 ± 0.31^*	4.18 ± 0.46^*#△	3.81 ± 0.37^*△▲
联合PPB组	47	2.92 ± 0.30	3.22 ± 0.42^*	3.32 ± 0.34^*	3.83 ± 0.38^*#△	3.12 ± 0.29^*△▲
t/F值		5.306	45.510	51.614	6.150	42.414
P值		< 0.001	< 0.001	< 0.001	0.015	< 0.001

组别	例数	舒芬太尼累积用量/μg	需要术后补救镇痛次数	疼痛主要部分/［例（%）］
组别	例数	舒芬太尼累积用量/μg	需要术后补救镇痛次数	前	后
ACB组	43	83.26 ± 12.15	6.75 ± 2.04	28（65.12）	36（83.72）
联合PPB组	47	68.51 ± 8.20	3.46 ± 1.03	31（65.96）	20（42.55）
t值		6.800	9.523	0.007	16.190
P值		< 0.001	< 0.001	0.933	< 0.001

Application of adductor canal block combined with popliteal plexus block in arthroscopic ligament reconstruction

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组别	例数	呕吐	瘙痒	水肿	过度镇静	总发生率
ACB组	43	0（0）	0（0）	0（0）	1（2.33）	1（2.33）
联合PPB组	47	0（0）	1（2.13）	0（0）	0（0）	1（2.13）
χ²值						0.004
P值						0.949

组别	例数	住院时间/d	主动直腿抬高时间/d	镇痛满意度/分
ACB组	43	7.94 ± 1.32	3.42 ± 0.38	2.19 ± 0.25
联合PPB组	47	7.20 ± 1.27	3.03 ± 0.41	2.42 ± 0.31
t值		2.705	4.683	3.889
P值		0.008	< 0.001	< 0.001

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