全膝置换术后关节内注射鸡尾酒式镇痛混合剂对镇痛效果的评价

目的 评价全膝关节置换术后关节内注射鸡尾酒式镇痛混合剂的镇痛效果和安全性.方法 将80例行单侧TKA的骨关节炎患者进行随机分配:试验组关节内注射鸡尾酒式镇痛混合剂(吗啡、布比卡因、复方倍他米松),对照组注射生理盐水.术后48h内均经静脉镇痛泵滴注吗啡行自控镇痛,疼痛难以忍受时,肌内注射吗啡5~10mg.比较两组患者术后膝关节静息和活动VAS疼痛评分、吗啡使用情况、主动直腿抬高时间、屈膝90°时间、膝关节活动度以及并发症.结果 采用关节内鸡尾酒式镇痛混合剂注射后,可以显著减少术后0~36h各时间段和总的吗啡使用量,并推迟术后第一次肌内注射吗啡的时间.术后第6、10、24、36h试验组静息痛VAS评分显著小于对照组,术后24、36h试验组活动痛VAS评分显著小于对照组.患者主动直腿抬高时间、屈膝90°时间以及术后15天膝关节活动度比较,试验组均优于对照组.两组在术后伤口愈合、感染发生率、血压、心率、皮疹、呼吸抑制和尿潴留的监测等方面进行比较,差异均无统计学意义,恶心呕吐发生率试验组小于对照组.结论 关节内鸡尾酒式镇痛混合剂注射有助于减少术后麻醉镇痛剂使用量,减轻术后早期疼痛,且没有明显的不良反应.

The efficacy of intra-articular cocktail analgesic mixture injection in total knee arthroplasty

Objective To evaluate the clinical efficacy and safety of intra-articular cocktail analgesic mixture injection after total knee arthroplasty (TKA). Methods A total of 80 patients with osteoarthritis who underwent unilateral TKA were equally randomized prospectively into two groups: trial group, where patients received intra-articular cocktail analgesic mixture injection containing morphine, bupivacaine and betamethasone, and control group, where patients received normal saline as control. All patients received patient-controlled analgesia (PCA) for 48h postoperatively. Visual analog score (VAS) for pain during activity and at rest, narcotic consumption, the time of ability to perform an active straight leg raise, the time of ability to reach 90 degree knee flexion, range of motion and complications were assessed and compared between the two groups. Results Intra-articular cocktail analgesic mixture injection significantly reduced the narcotic consumption during the 0-36h postoperative period and the total narcotic consumption, and delayed the initial use of the narcotics. VAS of rest pain of trial group at postoperative 6, 10, 24 and 36h was significantly lower than that of control group, and VAS of movement pain of trial group at postoperative 24, 36h was significantly lower than that of control group. The time of ability to perform an active straight leg raise and to actively reach 90 degree knee flexion, as well as ROM of the knee at the 15th postoperative day, were better in trial group than those in control group. There were no significant differences in postoperative wound healing, infection, blood pressure, heart rate, rash, respiratory depression, and urine retention between the two groups. The occurrence of nausea and vomiting of trial group was lower than that of control group. Conclusion Intra-articular cocktail analgesic mixture injection reduces narcotic consumption and offers a better pain control, without apparent risks following TKA.