膝關節置換術後，接受股神經阻斷術病人的疼痛及膝關節活動度之成效分析

Analysis of the Effects of Femoral Nerve Block on Pain Level and Knee Mobility in Patients With Total Knee Replacement

背景：退化性膝關節炎是高齡族群常見的失能和降低生活品質原因之一，膝關節置換手術是末期的治療方式，術後疼痛影響著膝關節角度及復健運動的執行。 目的：探討全膝關節置換術後立即介入單次股神經阻斷術（femoral nerve block, FNB），對於術後疼痛及膝關節活動度的成效。 方法：採類實驗性雙組前、後測研究設計並進行縱貫性追蹤，接受股神經阻斷術組（FNB組）與未接受股神經阻斷術組（ 非FNB組）各86人。研究工具包括：數字等級疼痛量表（Numerical Rating Scale），膝關節屈曲角度。測量與追蹤時間包括住院日（T0）及手術後第1、2、3、4天（T1-T4）。 結果：手術後第一天到第三天的疼痛程度，FNB組顯著低於非FNB組（p < .001）。手術後第一天到第四天止痛藥需求，FNB顯著少於非FNB組（p < .01）。連續性被動運動（continuous passive motion）角度手術後第一天到第四天兩組的角度呈現顯著差異（p < .05）。膝關節屈曲角度在住院日和出院日兩組有顯著差異（p < .001）。 結論／ 實務應用：本研究證實全膝關節置換術後介入股神經阻斷術，對疼痛緩解及膝關節活動度恢復成效顯著，供臨床術後照護參考。

Background: Osteoarthritis is a common cause of inactivity and reduced quality of life in the elderly. Total knee replacement (TKR) surgery, a last-stage treatment option for osteoarthritis, often results in postoperative pain that influences knee flexion and the ability to perform prescribed rehabilitation exercises. Purpose: This study was designed to examine the effectiveness of single femoral nerve block (FNB) on pain level and knee mobility in patients with TKR. Method: A quasi-experimental, two-group, longitudinal study was designed. The participants were distributed into the FNB group (n = 86) and non-FNB group (n = 86). The outcome measurements included pain scale (Numerical Rating Scale) score and knee continuous passive motion knee flexion angle. The five assessments and followed-up times were as follows: admission day (T0) and post-surgery day 1, 2, 3, and 4. Results: The results of the generalized estimating equations model showed that the pain level in the FNB group was significantly lower than in the non-FNB group, (p < .001). In terms of analgesics demand from post-surgery day 1 to day 4, the FNB group exhibited a significantly lower demand than the non-FNB group (p < .01). In addition, significant differences in the continuous passive motion rehabilitation exercise angle were found between the two groups from post-surgery day 1 through day 4 (p < .05). Finally, significant differences in knee flexion angles between the two groups were observed between hospital admission and discharge (p < .001). Conclusion/ Implications for Practice: The findings of this study support the positive effects of the femoral nerve block intervention on patients who receive total knee replacement surgery. The results were significant in terms of pain relief and knee mobility recovery. This intervention should be made available for use in the clinical care of TKR patients.