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1.
目的研究人工全膝关节置换术(TKA)术中关节周围注射布比卡因、吗啡、肾上腺素等混合药物的止痛效果,同时观察术后冷冻压迫法的疗效。方法将80例TKA患者随机分为四组,记录VAS评分,比较周径变化,测量膝关节活动度。结果术中关节周围注射镇痛药物和术后持续性冷冻压迫在术后镇痛、术后减轻肿胀和增加关节活动度上效果显著。结论TKA术中关节周围镇痛药物注射和术后持续性冷冻压迫可以在术后早期控制疼痛、减轻肿胀、改善关节活动度、促进早期康复。  相似文献   

2.
全膝关节置换术后持续性冷冻压迫法疗效分析   总被引:2,自引:0,他引:2  
目的 前瞻性评价持续性冷冻压迫法对全膝关节置换术后患者的疗效.方法 60例患者运用冷冻法(改良冰袋法),60例患者为对照组,比较两组术后3天髌骨上极2cm、髌骨中点、腓肠肌最粗点周径差,术前、术后6、12、24、36、48、72小时分别记录静止和活动视觉模拟疼痛评分(VAS评分),记录术前、术后3天、术后第1周、术后第2周膝关节活动度.冰袋运用后每隔10分钟测量膝关节周围温度,直至冰袋更换为止.结果 冷冻压迫组与对照组相比,术后第1天髌骨上极2cm、髌骨中点、腓肠肌最粗点周径差明显减少,两组术后第2、3天的差异无统计学意义.冷冻压迫组术后6、12、24小时静止和运动VAS评分明显低于对照组,两组相比有统计学差异,两组术后36、48、72小时静止和运动VAS评分无统计学意义.冷冻压迫组术后3天的膝关节活动度显著优于对照组,两组术后第1、2周膝关节活动度无差异性.冷冻压迫组术后引流量低于对照组.冷冻压迫组膝关节周围温度最低至15 ℃,对照组为30~32 ℃,两者相比有统计学差异.冷冻压迫组完全能够耐受持续冰敷,没有出现因冰敷引起的不适反应.结论 改良冰袋法经济有效,可以在术后早期减轻肿胀和疼痛,改善关节活动度,减少并发症,促进早期康复.  相似文献   

3.
目的 综述人工全膝关节置换术(total knee arthroplasty,TKA)术中关节周围局部浸润麻醉(local infiltration analgesia,LIA)注射部位的研究进展。方法 广泛查阅国内外相关文献,阐述膝关节疼痛发生相关机制和神经解剖学,并总结临床研究中LIA注射部位的选择和不同注射部位的临床效果差异。结果 膝关节各组织中存在大量伤害感受器,其中髌腱、髌下脂肪垫、外侧副韧带附着处、髂胫束附着处、髌上囊、后方关节囊等部位对疼痛更加敏感。目前大多数研究支持对侧方关节囊、侧副韧带、支持带、股四头肌肌腱、脂肪垫和皮下组织进行注射,是否对膝关节后部及骨膜下进行注射则存在争议。结论 膝关节各组织对疼痛敏感性的差别,对TKA术中LIA注射部位的选择具有指导意义。有关TKA术中LIA注射部位的选择虽已有临床研究,但存在一定局限性,仍未确定最优方案,有待进一步研究明确。  相似文献   

4.
人工全膝关节置换术后感染的临床分析   总被引:26,自引:0,他引:26  
Kou B  Lü H  Yuan Y  Yan T  Zhou D 《中华外科杂志》2000,38(4):253-255
目的 探讨全膝关节置换术后感染的原因、处理方法及临床效果。 方法 对 1987年~ 1999年 13例全膝关节置换术后感染患者的病因以及清创、一期或二期再置换等治疗方法进行总结分析。 13例患者术前膝关节平均活动度为 5 5°,HSS评分为 36 5分 ;平均随访 3年 5个月。 结果 13例感染患者经治疗后均未复发 ,80 %的患者对手术满意 ;膝关节活动度恢复至平均 85° ,HSS评分为73 5分。 结论 类风湿关节炎 (RA)、服用激素、合并糖尿病、使用铰链式假体及初次置换术前膝关节曾行其它手术是膝关节术后感染的高危因素 ;感染明确后 ,应积极进行清创合并应用敏感抗生素 ;二期置换的临床效果优于单纯清创及一期置换  相似文献   

5.
目的总结人工全膝关节置换术(total knee arthroplasty,TKA)后保持膝关节屈曲位对术后失血及早期膝关节活动度影响的研究进展。方法查阅近年国内外有关文献,就TKA术后保持膝关节屈曲位减少失血及增加膝关节活动度的作用机制,膝关节屈曲及伸直位、不同屈曲角度及维持时间的疗效差异进行总结。结果TKA术后膝关节保持屈曲位可通过血管成角变化等减少术后失血、提高屈肌肌力,进而增加膝关节活动度。膝关节屈曲角度较大、维持屈曲位时间较长时,可显著改善术后失血和膝关节活动度;但维持时间≥24 h与<24 h相比,不能进一步减少失血并改善膝关节活动度。结论TKA术后保持膝关节屈曲位是减少术后失血,提高早期膝关节活动度的简单、有效方法,但膝关节最佳屈曲角度及维持时间有待进一步探究。  相似文献   

6.
人工全膝关节置换术治疗膝关节骨关节炎   总被引:1,自引:0,他引:1  
目的评价人工膝关节置换术治疗膝关节骨关节炎的临床疗效,探讨人工膝关节置换术后并发症的原因。方法本组24例30膝膝关节骨关节炎患者进行人工全膝关节置换术,一期单膝置换18例,双膝同时置换6例,均采用后方稳定性假体。结果本组随访1~4年,平均2年。应用HSS膝关节评分系统进行分析,优24膝,良3膝,可2膝,差1膝,优良率90%。并发症:腓总神经损伤2例,人工膝关节脱位1例,有1膝差25°不能完全伸直。结论人工全膝关节置换术是治疗严重膝关节骨关节炎的有效方法,正确进行人工膝关节置换的手术操作是取得满意临床效果的保证。  相似文献   

7.
人工全膝关节置换术的护理体会   总被引:1,自引:0,他引:1  
  相似文献   

8.
目的 探讨按摩疗法对人工全膝关节置换术(total knee arthroplasty,TKA)术后患者疼痛的影响。方法 选取我院拟行单膝 TKA 患者 142 例,分成对照组和观察组,每组 71 例。对照组患者 TKA 术后行常规术后护理,观察组患者 TKA 术后在常规术后护理基础上行按摩疗法。结果 观察组患者术后 6、12、18 和 24 h 疼痛评分和均显著低于对照组患者(P<0.05);观察组患者术后6、12 和24 h 焦虑率显著低于对照组患者(P<0.05);观察组患者术后6、12 和24 h 吗啡用量均显著低于对照组患者(P<0.05);观察组患者术后满意度评分显著高于对照组患者(P<0.05)。结论 按摩疗法可显著降低 TKA 术后患者疼痛和焦虑感,减少患者镇痛药物使用,提高患者术后满意度。  相似文献   

9.
目的总结人工全膝关节置换术后早期康复护理体会。方法随机将60例人工全膝关节置换术后的患者分为2组,每组30例。对照组行常规护理,康复组在常规护理基础上采取早期康复护理。结果康复组术后下床活动时间及术后住院时间、第3天和1周的VAS评分,以及住院期间DVT发生率均优于对照组,差异均有统计学意义(P<0.05)。术后随访8~12个月。康复组术后1个月及6个月时的HSS评分和Barthel指数均优于对照组,差异均有统计学意义(P<0.05)。结论对人工全膝关节置换手术后的患者开展早期康复护理,能有效缓解疼痛程度、降低术后并发症风险,促进膝关节功能及生活能力恢复。  相似文献   

10.
目的 比较吗啡关节周围联合药物注射(PMDI)和鞘内注射对人工全膝关节置换术(TKA)患者术后疼痛和关节功能的影响。方法 回顾分析我院行TKA患者153例,按照麻醉方式分成对照组、PMDI组和鞘内注射组,每组51例。对照组患者接受常规腰麻及关节周围软组织注射,PMDI组患者关节周围额外注射10 mg盐酸吗啡注射液,鞘内注射组患者腰麻药物中额外加入0.1 mg盐酸吗啡注射液。记录三组患者术后疼痛视觉模拟量表(VAS)评分。记录三组患者术后追加曲马多用量和首次追加曲马多时间。记录三组患者术后患肢主动关节屈曲角度。记录三组患者术后呕吐次数和术后止呕药物使用次数。结果 术后6、12和24 h PMDI组和鞘内注射组患者术后疼痛VAS评分显著低于对照组患者(P<0.05),术后6、12和24 h鞘内注射组患者术后疼痛VAS评分显著低于PMDI组患者(P<0.05)。术后12 h和24 h PMDI组和鞘内注射组患者追加曲马多用量显著低于对照组患者(P<0.05),术后12 h和24 h 鞘内注射组患者追加曲马多用量显著低于PMDI组患者(P<0.05)。PMDI组和鞘内注射组患者术后首次追加曲马多时间显著低于对照组患者(P<0.05),鞘内注射组患者术后首次追加曲马多时间显著低于PMDI组患者(P<0.05)。术后12 h和24 h PMDI组和鞘内注射组患者术后患肢主动关节屈曲角度显著高于对照组患者(P<0.05),术后12 h和24 h 鞘内注射组患者术后患肢主动关节屈曲角度显著高于PMDI组患者(P<0.05)。术后12 h、24 h和48 h PMDI组和鞘内注射组患者术后呕吐次数和术后止呕药物使用次数显著高于对照组患者(P<0.05),术后12 h、24 h和48 h PMDI组患者术后呕吐次数和术后止呕药物使用次数显著高于鞘内注射组患者(P<0.05)。结论 吗啡PMDI和吗啡Ⅱ均为有效的TKA术后镇痛方法,其中吗啡Ⅱ较吗啡PMDI可进一步缓解TKA术后患者疼痛,加快患者早期关节功能恢复。但吗啡PMDI和吗啡Ⅱ均会增加TKA术后呕吐发生率,需要临床医生重视。  相似文献   

11.
The efficacy of periarticular multimodal drug injection (PMDI) to reduce pain after total knee or hip arthroplasty (TKA or THA) still remains controversial. Our study aimed at evaluating the efficacy of PMDI after TKA or THA. A fully recursive literature search was conducted to identify relevant randomized controlled trials. Ultimately, 21 studies were included in the analysis. Pooled results showed that the PMDI group had better pain relief, less opioid consumption, larger range of motion, and lower rates of nausea and vomiting than the placebo group. No significant difference was seen in regard to the length of hospital stay between the two groups. In conclusion, PMDI should be recommended for the pain management after TKA or THA.  相似文献   

12.
The purpose of this study was to compare a novel liposomal bupivacaine to traditional peri-articular injection (PAI) in a multi-modal pain protocol for total knee arthroplasty (TKA). A retrospective cohort study compared 85 consecutive patients undergoing TKA with a traditional PAI of ropivacaine, epinephrine and morphine to 65 patients with a liposomal bupivacaine PAI. After the initial 24 h, inpatient self-reported pain scores were higher in the liposomal bupivacaine group compared to the traditional PAI group (P = 0.04) and a smaller percentage (16.9%) of patients in the liposomal bupivacaine group rated their pain as “mild” compared to the traditional group (47.6%). Liposomal bupivacaine PAI provided inferior pain control compared to the less expensive traditional PAI in a multi-modal pain control program in patients undergoing TKA.  相似文献   

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《The Journal of arthroplasty》2022,37(10):1928-1938.e9
BackgroundPeriarticular injection (PAI) is administered intraoperatively to help reduce postoperative pain and opioid consumption after primary total joint arthroplasty (TJA). The purpose of this study was to evaluate the efficacy and safety of PAI in primary TJA to support the combined clinical practice guidelines of the American Association of Hip and Knee Surgeons, American Academy of Orthopaedic Surgeons, Hip Society, Knee Society, and American Society of Regional Anesthesia and Pain Medicine.MethodsThe MEDLINE, Embase, and Cochrane Central Register of Controlled Trials databases were searched for studies published prior to March 2020 on PAI in TJA. All included studies underwent qualitative and quantitative homogeneity testing followed by a systematic review and direct comparison meta-analysis to assess the efficacy and safety of PAI.ResultsThree thousand six hundred and ninety nine publications were critically appraised to provide 60 studies regarded as the best available evidence for an analysis. The meta-analysis showed that intraoperative PAI reduces postoperative pain and opioid consumption. Adding ketorolac or a corticosteroid to a long-acting local anesthetic (eg, ropivacaine or bupivacaine) provides an additional benefit. There is no difference between liposomal bupivacaine and other nonliposomal long-acting local anesthetics. Morphine does not provide any additive benefit in postoperative pain and opioid consumption and may increase postoperative nausea and vomiting. There is insufficient evidence to draw conclusions on the use of epinephrine and clonidine.ConclusionStrong evidence supports the use of a PAI with a long-acting local anesthetic to reduce postoperative pain and opioid consumption. Adding a corticosteroid and/or ketorolac to a long-acting local anesthetic further reduces postoperative pain and may reduce opioid consumption. Morphine has no additive effect and there is insufficient evidence on epinephrine and clonidine.  相似文献   

15.

Background

Total knee arthroplasty (TKA) is gradually emerging as the treatment of choice for end-stage osteoarthritis. In the past, the method of liposomal bupivacaine by periarticular injection (PAI) showed better effects on pain reduction and opioid consumption after surgery. However, some recent studies have reported that liposomal bupivacaine by PAI did not improve pain control and functional recovery in patients undergoing TKA. Therefore, this meta-analysis was conducted to determine whether liposomal bupivacaine provides better pain relief and functional recovery after TKA.

Methods

Web of Science, PubMed, Embase, and the Cochrane Library were comprehensively searched. Randomized controlled trials, controlled clinical trials, and cohort studies were included in our meta-analysis. Eleven studies that compared liposomal bupivacaine using the PAI technique with the conventional PAI method were included in our meta-analysis. The preferred reporting items for systematic reviews and meta-analyses (PRISMA) guidelines and Cochrane Handbook were applied to assess the quality of the results published in all included studies to ensure that the results of our meta-analysis were reliable and veritable.

Results

Our pooled data analysis demonstrated that liposomal bupivacaine was as effective as the control group in terms of visual analog scale score at 24 hours (P = .46), 48 hours (P = .43), 72 hours (P = .21), total amount of opioid consumption (P = .25), range of motion (P = .28), length of hospital stay (P = .53), postoperative nausea (P = .34), and ambulation distance (P = .07).

Conclusion

Compared with the conventional PAI method, liposomal bupivacaine shows similar pain control and functional recovery after TKA. Considering the cost for pain control, liposomal bupivacaine is not worthy of being recommended as a long-acting alternative analgesic agent using the PAI method.  相似文献   

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In patients undergoing surgery, optimal pain management is associated with improved perioperative outcomes, patient satisfaction with surgery, and a more rapid functional recovery. In recent years, the employment of multimodal pain management strategies has become increasingly widespread. In particular, there has been an explosion in the use of peripheral nerve blockade and periarticular injections in total knee arthroplasty. However, there is significant variability in the administration of either modality of anesthesia. As such, a critical evaluation of the current literature is warranted to elucidate the advantages and disadvantages of each technique with the ultimate goal of further refining current pain control strategies. In this symposium, we review each of these modalities and their association with pain management, narcotic consumption, length of hospital stay, and adverse events.  相似文献   

17.

Background

Currently, various techniques are used to overcome postoperative pain after total knee arthroplasty. A local analgesic infiltration with periarticular multimodal drug injection (PMDI) is favorable because of its simplicity, safety, and efficacy. The present study compared the efficacy of a PMDI at the anterior vs posterior compartments.

Methods

Forty-six patients were randomized to receive the PMDI at either the anterior or posterior compartment, with the contralateral knee receiving the PMDI at the opposite compartment. The PMDI injected to the posterior capsule, medial and lateral meniscal remnant, was defined as the posterior compartment injection, whereas the injection to the medial retinaculum, quadriceps muscle, pes anserinus, and retropatellar fat pad was defined as the anterior compartment injection. Pain scores at rest, knee flexion angle, quadriceps function, and drainage blood loss were evaluated in both groups.

Results

The anterior PMDI group had significantly lower pain scores at rest during 96 hours postoperatively. On the day of discharge, 19 patients (41.3%) favored the knee with the anterior PMDI, which was superior to 9 patients (19.6%) who favored the knee with the posterior PMDI. The anterior PMDI demonstrated a superior recovery of quadriceps function during the same period, but there was no significant difference in terms of other parameters.

Conclusion

The PMDI at the anterior compartment can reduce pain after total knee arthroplasty with potentially better quadriceps function compared with that in the PMDI at the posterior compartment. We recommend infiltrating the anterior compartment with a greater amount of PMDI than the posterior compartment.  相似文献   

18.

Objective

Preemptive multimodal analgesia is a frequently utilized method for controlling pain after total knee arthroplasty (TKA). So far, no studies have specifically examined the efficacy of adding acetaminophen to preemptive multimodal analgesia in TKA. The current work aimed to assess the efficacy of adding acetaminophen to preemptive multimodal analgesia for clinical pain management after TKA.

Methods

This was a double-blinded randomized study including 80 cases randomized to the acetaminophen and control groups, respectively. The acetaminophen group was administered celecoxib at 400 mg, pregabalin at 150 mg, and acetaminophen at 300 mg 2 h before TKA. Control patients were administered celecoxib, pregabalin, and placebo. The primary outcome was postsurgical use of morphine hydrochloride for rescue analgesia. Secondary outcomes included the time to the initial rescue analgesia, postsurgical pain as determined by a visual analogue scale (VAS), functional recovery as reflected by the range of knee motion and ambulation distance, hospitalization duration, and complication rates. Continuous data with normal and skewed distributions were compared by the Student's t test and the Mann–Whitney U test, respectively. Categorical variables were compared by the Pearson's chi-squared test.

Results

The control and acetaminophen groups were comparable in postoperative 0–24 h morphine consumption (11.3 ± 6.5 mg vs 12.3 ± 7.7 mg, P = 0.445) and total morphine consumption (17.3 ± 10.1 mg vs 19.3 ± 9.4 mg, P = 0.242). Additionally, time to the initial rescue analgesia, postoperative VAS score at any time point, postoperative functional recovery of the knee, and hospitalization duration were similar in both groups. Both groups also had similar occurrence rates of postoperative complications.

Conclusions

In this study, adding acetaminophen to preoperative preemptive multimodal analgesia did not decrease postoperative morphine use or ameliorate pain relief. The efficacy of adding acetaminophen to preemptive multimodal analgesia in TKA need to be further explored in future studies.  相似文献   

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