Abstract: ［Abstract］ Objective To compare the difference of postoperative analgesic effects after total knee replacement between the sciatic nerve block and the periarticular local infiltration anesthesia around the joint. Methods Thirty-three patients with total knee surgery，ASA class Ⅰ or Ⅱ，were divided into sciatic nerve block groups（SNB group，n=16，the patients were given 20 ml of 0.375% ropivacaine for sciatic nerve block）；local infiltration anesthesia group （LIA group，n=17，the patients were given mixed local anesthetics including 150 ml of 0.2% of ropivacaine，100 mg of tramadol and 0.5 mg of epinephrine for periarticular local infiltration anesthesia. The VAS scores in the static state and the active state were recorded and evaluated at 2，8，16，24，36 and 48 hours postoperatively. Postoperative nausea and vomiting，the symptoms of local anaesthesia poisoning，the occurrence of rashes，and the status of KSS scores in the two groups were observed. Results Compared with the SNB group，static VAS scores of LIA group was higher at postoperative 2，8，16 hours，with statistically significant differences （P<0.01），but the scores were reduced at postoperative 24，36 and 48 hours，with statistically significant differences （P<0.01）. Compared with the SNB group，motional VAS scores of LIA group was higher at postoperative 2 and 8 hours，with statistically significant differences（P<0.01）， but the scores were reduced at postoperative 16，24，36 and 48 hours，with statistically significant differences（P<0.01）. The two groups of patients were similar in postoperative nausea and vomiting，the symptoms of anesthetic poisoning，rash occurrence，and KSS score，without statistically significant differences. Conclusion SNB or LIA can provide good postoperative analgesic effect for total knee surgery，but the latter is more suitable for such operations from the perspective of convenient procedures.

Key words: total knee replacement, sciatic nerve block, local infiltration anesthesia

摘要： ［摘要］ 目的 比较坐骨神经阻滞和关节周围局部浸润麻醉对全膝关节置换手术术后镇痛效果的差异。方法 采用前瞻性研究方法，33 名符合条件的全膝关节手术患者，ASA 分级Ⅰ或 Ⅱ级，分为坐骨神经阻滞组（SNB 组，16 例，术毕给予 0.375% 罗哌卡因 20 mL 进行坐骨神经阻滞）；局部浸润麻醉组（LIA 组，17 例，术毕给予 0.2 %的罗哌卡因 150 mL 加曲马多 100 mg 和 0.5 mg 肾上腺素混合液行膝关节周围局部浸润麻醉）。于术后 2 h、8 h、16 h、24 h、36 h、48 h 评估静止状态下和活动状态下VAS 评分分值的变化；观察术后恶心呕吐发生，局麻药中毒症状，皮疹发生，KSS 评分在两组患者中的状况。结果 ①与SNB 组相比，术后 2 h、8 h、16 h LIA 组患者静止状态下的 VAS 评分偏高，差异有统计学意义（P<0.01），但术后 24 h、36 h 和 48 h LIA 组患者的评分降低，差异有统计学意义（P<0.01）；②与 SNB 组相比，LIA 组患者术后 2 h、8 h 运动状态下 VAS评分偏高，差异有统计学意义（P<0.01），LIA 组患者在术后16 h、24 h、36 h 和48 h 的评分降低，差异有统计学意义（P<0.01）；③两组患者术后恶心呕吐发生，局麻药中毒症状，皮疹发生，KSS 评分情况，差异无统计学意义。结论 SNB 或者LIA 都能为全膝关节手术提供良好的术后镇痛效果， 但从操作便捷的角度来看，后者更适用于此类手术。

关键词: 全膝关节置换术, 坐骨神经阻滞, 局部局部浸润麻醉