局部注射含氯诺昔康的镇痛药物抑制痛觉致敏作用对全膝关节置换手术后疼痛控制的影响研究

目的探讨术中局部注射含氯诺昔康的镇痛药物配方与传统布比卡因配方对全膝关节置换术（TKA）术后疼痛控制的影响.方法 选择2008年1月～2009年8月在第三军医大学西南医院关节外科中心行TKA术的骨关节炎患者.将符合双盲对比研究的患者随机分为两组,传统布比卡因组（A组）78例,加用氯诺昔康组79例（B组）.所有患者施行标准化围手术期口服药物和神经阻滞PCA持续镇痛,每12小时记录术患者后疼痛评估结果,包括：（1）患者静息和被动活动VAS评分;（2）股四头肌肌力;（3）镇痛泵药品消耗量.结果 157例患者中共有12例被剔除.术后12 h两组间的指标无统计学差异（P〉0.05）;术后12～48 h,A组镇痛泵药物用量与B组有统计学差异（P〈0.05）;术后24～96 h,B组被动活动痛VAS评分与A组有统计学差异（P〈0.05）.两组患者间肌力无统计学差异（P〉0.05）.结论 TKA术区局部镇痛药物配方中NSAIDS药物的使用对术后早期镇痛的效果明显优于传统的布比卡因配方.其镇痛作用延长至术后96 h仍明显优于传统布比卡因配方,可能与消除了痛觉致敏有关.

Local injection with lornoxicam in postoeprative pain control after TKA

Objective To evaluate effects of local infiltration with drugs containting loruoxicam in management of postoperative pain after total knee arthroplasty, compared with using bupivacaine only. Methods A consecutive series of 157 patients with knee osteoarthritis undergoing TKA from January, 2008 to August, 2009 in our center were included in this random double-blind study. Bupivacaine group： 78 cases; Loruoxicam group： 79 cases. All patients received standard perioperative medication and paranerve PCA pain control. Evaluation of pain was recorded every 12 hours. The following parameters were recorded： （ 1 ） VAS score of rest pain and passive movement pain ; （2） quadriceps strength; （3） medicine usage of PCA pump. Results 12 patients out of 157 cases were excluded from the study. There was no significant difference between the two groups at 12 hours after operation; dosage of PCA medicine in group A was lager than group B from 12 to 24 hours after operation. VAS score and dosage of PCA in group B were smaller than group A from 24 to 48 hours after operation. There was no significant difference of muscle strength between the two groups. Conclusions Compared with traditional Bupivacaine infiltration mixture, local infiltration with drugs containing NSAIDS has better effect in pain control. The superiority in analgesic effect prolonged up to 96 hours postoperatively, and it may be related to decrease of allodynia.