目的： 比较连续收肌管阻滞（adductor canal block, ACB）与连续股神经阻滞（femoral nerve block, FNB）在全膝关节置换术后的临床效果。方法： 前瞻性观察2016年4—9月因重度退行性骨关节炎行单侧、初次膝关节置换的患者，随机分为ACB组和FNB组。记录患者术后2、6、12、24、48 h静息及运动状态下运用疼痛数字分级法（numeric pain rating scales, NPRS）进行的镇痛评分、术前及术后24、48 h股四头肌肌力、术后48 h内阿片类药物追加使用量、术后不良反应等。结果： 共纳入40例患者，每组各20例，男 ∶女=7 ∶33，年龄（63.8±10.1）岁，体重指数（body mass index，BMI）为（28.5±3.5）kg/m2。两组患者在美国麻醉学会(American Society of Anesthesiologists, ASA)评分、术前畸形程度、疼痛评分、股四头肌肌力、手术时间和止血带使用时间方面差异无统计学意义。除术后2 h的静息痛［ACB=0.0(0,6),FNB=3.0(0,5),P=0.004］和术后12 h的运动痛［ACB=3.0(3,0), FNB=5.5(0,10)，P=0.004）外，其他时点两组疼痛评分差异均无统计学意义（P＞0.05）。术后24、48 h股四头肌肌力，ACB组为（85.3±27.6） N和（82.0±30.1） N，FNB组为（69.0±29.4） N和（64.4±32.0） N，两组均随时间变化呈下降趋势，尽管具体数值ACB组高于FNB组，但组间差异无统计学意义（F=2.703，P=0.108）。术后24 h内追加使用盐酸哌替啶（100 mg/次）者，ACB组有4例，FNB组有5例；术后24~48 h内追加者，ACB组3例，FNB组2例；所有追加均为1次。ACB组中，5例患者出现术后恶心，另有1例感到口干；FNB组恶心者4例，均同时伴有呕吐，另有口干者3例，下肢肌间血栓患者2例。结论： 膝关节置换术后，连续ACB的镇痛效果并不优于连续FNB，但ACB减小了对术后股四头肌力的影响，有利于术后早期活动。

Objective： To compare the pain control efficiency of continuous adductor canal block (ACB) and femoral nerve block (FNB) in total knee arthroplasty. Methods: From April to September 2016, patients with severe knee osteoarthritis undergoing primary unilateral total knee arthroplasty (TKA) were prospectively observed, and all the patients were randomized received ultrasound-guided continuous ACB or FNB after surgery. Numeric pain rating scales（NPRS）pain scores in rest and activity 2, 6, 12, 24 and 48 h after surgery were collected, and the preoperative and postoperative quadriceps strength at 24 and 48 h were analyzed. Opioids consumption and anesthesia related adverse effects were also recorded. Results: In the study, 40 patients were enrolled, with 20 patients in each group, male ∶female=7 ∶33, the age: (63.8±10.1) years , and the body mass index (BMI): (28.5±3.5) kg/m2.The general conditions were comparable between the two groups. Though the rest pain 2 h after surgery ［ACB=0.0(0,6), FNB=3.0(0,5), P=0.004］ and activity pain 12 h post operation ［ACB=3.0(3,0), FNB=5.5(0,10), P=0.004］ were lower in ACB group compared with FNB group, there was no statistical difference in the other pain checking points between the two groups. The quadriceps strength 24 h and 48 h after surgery were(85.3±27.6) N and (80.0±30.1) N in ACB group, (69.0±29.4) N and (64.4±32.0) N in FNB group, both of them were declined by time. The exact data were higher in ACB group, however, there was no statistical difference between the two group by repeated measurements variance analysis（F=2.703, P=0.108）.Four patients in ACB group and five in FNB acquired additional use of dolantin once (100 mg/per time) within 24 h. And among them, three patients acquired once dolantin in ACB, two in FNB, from 24 to 48 h postoperation. There were five patients who suffered nausea postoperation in ACB group, and one who reported xerostomia. Four patients in FNB had nausea with vomiting, and three experienced xerostomia. Deep vein thrombosis appeared in 2 patients in FNB group, but no one in ACB group. Conclusion: Continuous ACB is not superior in pain control after TKA compared with FNB, and the quadriceps strength could be reserved more by this method, which performed early benefits in fast rehabilitation.