全膝关节置换术中关节周围局部注药镇痛效果的研究

目的]围手术期使用鸦片类药物或椎管内麻醉镇痛会带来很多副作用。良好的围手术期镇痛有利于康复,增加患者对医院的满意度,减少住院时间。作者做全膝关节假体周围注药疗效的研究。方法]38名全膝关节置换患者随机分为2组:一组接受吗啡、布比卡因、甲强龙、肾上腺素,而另外一组不接受注药。围手术期镇痛方案标准化。所有的患者术后48h接受患者自控式的镇痛,随访采用标准化镇痛方案。可视模拟的疼痛评分,记录患者在术前、术后和术后6周的疼痛评分。并衡量术后特定时间点的自控镇痛消耗量,全面的镇痛要求。结果]接受注药的患者术后24h注药组为(28.26±8.14)mg,对照组为(40.16±9.17)mg,t=4.229,P=0.00,注药组对镇痛的需求量显著降低;术后48h注药组为(48.79±11.43)mg,对照组为(66.58±10.93)mg,t=4.904,P=0.00,注药组对镇痛的要求显著降低。在术后24、48h使用的自控镇痛明显减少。术后复苏、术后4h、术后1d时的疼痛评分降低。未发现心脏和中枢神经系统的毒性。结论]全膝关节置换术中注射多种药物显著的降低了患者自控镇痛,提高了患者满意度,并且未见明显副作用。

Investigation about efficacy of periarticular drug injection in total knee arthroplasty

Objective]Postoperative analgesia with the use of parenteral opoids or epidural analgesia can be associated with troublesome side effects.Good perioperative analgesia facilitates rehabilitation,improves patient satisfaction,and may reduce the hospital stay.We investigated the analgesic effect of locally injected drugs around a total knee prosthesis.Method]Thirty-eight patients undergoing total knee arthroplasty were randomized either to reveive a periarticuiar intraoperative injection containing bupicaine,morphine,epinephrine,hydrocordisone or to reveive no injection.We compared the PCA consumption at the some time point after tatal knee arthroplasty.Visual analog scores for pain,preoperation and postoperation,6 weeks after operation were collected.Result]The patients who had received the injection used significantly less patient-controlled analgesia over the first 24 hours after the surgery.They had lower visual analog scores for pain 24 hours and 48 hours after operation.No cardiac or central nervous system toxicity was observed.Conclusion]The perioperative analgesia protocol improved patient satisfaction,pain control and minimizes side effects after total kneearthroplasty.