围手术期用药对降低人工膝关节置换术后疼痛的作用

目的探讨围手术期镇痛药物控制进行全膝关节置换（TKA）术后镇痛效果及临床疗效。方法选择64例单侧TKA的患者分为3组。A组：术前术后均口服塞来昔布,术中膝关节周围注射用药（2.5 mg/L布比卡因40 ml,1∶200 000的肾上腺素∶生理盐水30 ml。B组：术中未行膝关节周围注射,术前术后口服塞来昔布。C组：仅术中膝关节周围注射用药（同A组）。分别记录术前、术后静止与活动视觉模拟疼痛评分（VAS）和膝关节活动度。结果①VAS：A组术后6、12、24、36、48 h静止、运动VAS低于B、C组,差异有统计学意义（P〈0.05）;B、C组之间静止、运动VAS无明显差别（P〈0.05）;3组之间术后72 h静止和运动VAS间的差异无统计学意义。②膝关节活动度：A组术后第1、2、3天膝关节活动度均高于B、C组（P〈0.05）,而术后2周3组膝关节活动度比较差异无统计学意义。结论围手术期综合用药能有效控制TKA术后的疼痛,有利于关节功能早日恢复。

Perioperative medication to reduce pain after total knee replacement

Objective To study the effect of perioperative control of analgesic drugs in total hip arthroplasty（TKA）.Methods 64 patients with unilateral TKA surgery were divided into 3 groups： A group,patients were applied celecoxib before and after operation,and injected around the knee joint surgery（bupivacaine 2.5 mg/L total of 40 ml,epinephrine 1 ∶200 000 saline 30 ml）intraoperatively;B group,Intraoperative injection is not around the knee joint,preoperative and postoperative oral administration of celecoxib.C group： Intraoperative injection drug use only.All cases were recorded rest and activities of the visual analog pain score（VAS） and knee joint activity before and after surgery.Results ① VAS showed that： A group were 6,12,24,36,48 h VAS less than B,C group in rest and exercise,and the difference was statistically significant（P0.05）.B,C were no significant different（P0.05）.72 h after surgery among the 3 groups at rest and movement,VAS was no significant different.② Knee activity： A group of 1,2,3 days after surgery were higher than knee B,C group（P0.05）,and between the groups after 2 weeks,the degree was no significant different.Conclusions Comprehensive perioperative pain medication can effectively control pain after total knee replacement surgery,which is conducive to an early resumption of joint function.