人工全膝关节置换术中关节周围注射镇痛药物和术后持续性冷冻压迫的疗效分析

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。     

全膝关节置换术后持续性冷冻压迫法疗效分析

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.     

关节周围注射混合药物在全膝关节置换术围手术期多模式镇痛方案中的疗效评估

目的运用随机对照的前瞻性方法观察关节周围注射混合药物在全膝关节置换术（TKA）酮手术期多模式镇痛方案中的的止痛效果。方法60例单侧TKA患者随机分为研究组30例和对照组30例。所有患者术前24小时及术后第2天给予塞来昔布（西乐葆）200mg每天2次（术后6小时400mg口服）、氨酚曲马多（及通安）1片每天3次口服,连续使用5d;研究组患者术中膝关节周围注射镇痛药物（10g／L罗哌卡因20ml,吗啡10mg,复方倍他米松（得宝松）1ml,生理盐水80ml）,对照组患者没有运用关节周围注射药物。术后首次哌替啶注射6h后视患者疼痛情况再给予相同剂量注射1次。术前、术后分别记录静止与活动视觉模拟疼痛评分和膝关节活动度。结果58例患者进入统计学分析,其中对照组有2例在术后麻醉师给行静脉镇痛。（1）视觉模拟疼痛评分：研究组术后6、12、24、36、48h静止、运动视觉模拟疼痛评分低于对照组（P均〈0．01）,两组术后72h静止和运动视觉模拟疼痛评分间的差异无统计学意义（P〉0．05）;（2）膝关节活动度：研究组术后第1、2、3天膝关节活动度高于对照组（P均〈0．01）,两组术后第1、2周膝关节活动度间的差异无统计学意义;（3）并发症：两组术后没有发现任何因为注射而引起的伤口感染、延期愈合及组织坏死等并发症。结论TKA术中应用关节周围注射镇痛药物在可以在多模式镇痛方案中起一定作用：减少术后早期静止和活动状态疼痛评分、改善术后早期关节活动度。     

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。     

术中关节周围鸡尾酒注射在骨性关节炎患者初次全膝关节置换术后镇痛中的应用

目的探讨术中关节周围注射混合镇痛药物(鸡尾酒)在膝关节骨性关节炎初次全膝关节表面置换术后镇痛中的疗效。方法选取我院关节外科2017年1月～2017年12月收治的60例行单侧表面全膝关节置换术(TKA)的膝关节骨性关节炎患者为研究对象,按照是否注射鸡尾酒分为干预组、对照组,比较两组患者术后48 h、1周、1月、3月、6月的疼痛视觉模拟(VAS)评分、膝关节活动度(ROM)、美国膝关节协会评分(KSS评分)、患者满意度及不良反应、切口并发症。结果干预组术后48 h、1周的VAS评分低于对照组(P0.05),干预组术后48 h、1周ROM大于对照组(P0.05),干预组术后48 h、1周KSS评分高于对照组(P0.05),干预组术后48 h、1周满意度高于对照组(P0.05)。未发现切口并发症。以上指标在术后1月、3月、6月均无统计学差异(P0.05)。结论术中鸡尾酒注射在TKA术后早期镇痛疗效确切,可改善早期功能,改善住院体验,提高患者满意度,促进患者早期康复。     

膝关节局部注药在全膝关节置换镇痛中的应用

[目的]研究全膝关节置换(total knee arthroplasty,TKA)术中关节周围注射罗哌卡因、酮洛酸氨丁三醇、肾上腺素混合药物,联合术后关节腔内注射罗哌卡因、酮洛酸氨丁三醇对TKA的镇痛效果、术后康复的影响及副作用.[方法]选择在本院行单侧TKA的50例患者随机分为两组,研究组术中将罗哌卡因、酮洛酸氨丁三醇、肾上腺素的混合液注射在膝关节周围,术后48 h拔除引流管后,关节腔内注入罗哌卡因、酮洛酸氨丁三醇.对照组术中、术后均给予相同剂量的生理盐水作为对照.记录视觉模拟评分(VAS)、Rameasay镇静评分,CPM膝关节活动度及副作用,应用统计软件SPSS 13.0进行统计学分析.[结果]研究组术后6、12、24 h,第3、4 d的VAS评分均低于对照组,(t=3.49～2.34,P＜0.05),第2 d时VAS评分无差别(t=1.99,P＞0.05),CPM膝关节活动度在术后2～6 d高于对照组(t=3.030～2.112,P＜0.05),而在第7 d以后活动度无差别(t=1.997～2.020,P＞0.05).两组副作用无差别(x2值1.6571,P＞0.05).[结论]TKA术中关节周围注药联合术后关节腔内注药可在术后早期减轻疼痛、改善关节活动度、促进康复,且不会增加副作用.     

持续脉冲加压冷疗对全膝关节置换术后早期功能障碍的影响

目的观察持续脉冲加压冷疗对全膝关节置换术（TKA）后患者早期功能障碍的影响。方法采用随机、双盲法将2010年8月至2011年6月在广州军区广州总医院因膝关节骨性关节炎行TKA治疗的40例患者分为常规组与加压组,每组各20例。常规组采用生理盐水冰袋;加压组采用持续脉冲加压冷疗。评估患者术后早期膝关节肿胀程度、引流量、关节活动度及HSS评分等指标。结果加压组患者术后72h膝关节肿胀值和术后48h引流量较常规组减少（P〈0.05）;术后72h、2周主动关节活动度较常规组增加（P〈0.05）;术后2周HSS评分较常规组提高（P〈0.05）。结论持续脉冲加压冷疗有助于TKA术后患者早期消肿、减少引流量、增加关节活动范围、提高耐受性,可促进膝关节功能的整体康复。     

膝关节周围镇痛辅以糖皮质激素对全膝关节置换术后疗效评价的Meta分析

目的用Meta分析的方法研究膝关节周围注射混合镇痛是否辅以糖皮质激素对全膝关节置换(TKA)术后疼痛缓解及功能恢复的疗效分析。方法分别在PUBMED、Springer Link等国内外期刊中检索TKA术中关节周围混合镇痛药物辅以与未辅以糖皮质激素注射的病例对照相关文献,严格按照满足随机对照试验、干预措施等纳入标准和不符合纳入条件的排除标准对文献进行筛选并提取相关资料,通过Review Manager 5.0软件对资料进行Meta分析。结果最终共纳入随机对照试验7篇。资料分析显示,膝关节周围注射混合镇痛药辅以糖皮质激素对TKA后前2 d及1周膝前痛视觉模拟评分(VAS评分)可降低[MD=-0.92,95%CI(-1.70,-0.14),P=0.02;MD=-0.48,95%CI(-0.73,-0.22),P0.001;MD=-0.31,95%CI(-0.56,-0.05),P=0.02];直腿抬高试验平均所需时间可缩短[MD=-0.65,95%CI(-0.83,-0.47),P0.001]、平均住院日有缩短[MD=-1.34,95%CI(-1.74,-0.95),P0.001]、降低TKA后吗啡前2 d使用量[MD=-0.70,95%CI(-0.83,-0.57),P0.001;MD=-0.53,95%CI(-0.87,-0.18),P=0.003]。结论膝关节周围注射混合镇痛药辅以糖皮质激素可以缓解术后早期TKA膝关节疼痛,改善患肢抬高,缩短住院日,降低吗啡使用量,同时也未增加恶心呕吐发生率。     

伴有心脏疾患病人全膝关节置换术中关节周围大剂量布比卡因注射镇痛的疗效和安全性

[目的]研究人工全膝关节置换术(TKA)中关节周围软组织注射含有大剂量布比卡因的混合药物进行术后镇痛对于伴有心脏疾患病人的临床疗效以及有无毒副反应。[方法]35例准备进行单侧TKA的骨关节炎病人根据是否伴发心脏疾患分为心脏病组(12例)和非心脏病组(23例)。在围手术期所有患者按相同镇痛方案治疗,术中关节周围注射Ranawat Cocktail镇痛药液(包含0.75%布比卡因250 mg,吗啡4 mg,肾上腺素0.3 mg,甲基强的松龙40 mg,头孢唑啉0.5 g,生理盐水57 ml)。记录患者术后疼痛VAS评分、满意度、膝关节活动度、主动直腿抬高时间、伤口并发症、术后住院天数、心电图异常及心血管并发症等。[结果]两组病人术后VAS评分、满意度、膝关节活动度、主动直腿抬高时间和术后住院天数均无统计学差异,所有病人无伤口并发症以及心血管并发症发生。[结论]在TKA术中,关节周围注射含有大剂量布比卡因的Ranawat Cocktail混合药物对伴发心脏疾患的病人同样可以提供很好的术后镇痛效果,并且具有良好的安全性。     

全膝关节置换术围手术期镇痛研究进展

全膝关节置换术(TKA)围手术期的疼痛管理是TKA手术重要的一环,对疼痛的良好控制有助于减少术后相关并发症发生以及促进患者快速康复。口服镇痛药物、关节腔周围注射、外周神经阻滞等镇痛方式可以减轻患者术后疼痛,减少阿片类药物的应用及其不良反应,降低术后并发症发生的风险,但是目前还没有一种镇痛方式能够彻底缓解TKA围手术期疼痛。该文对目前TKA围手术期镇痛研究进展作一综述。     

Local Efficacy of Periarticular Morphine Injection in Simultaneous Bilateral Total Knee Arthroplasty: A Prospective,Randomized, Double-Blind Trial

Background

The periarticular multimodal cocktail injection including morphine is currently commonly used to reduce postoperative pain following total knee arthroplasty (TKA). Despite its analgesic effect, it frequently causes nausea, which is an adverse effect of opioids. It is inconclusive whether the intraoperative injection of periarticular morphine is effective peripherally. The aim of this study was to assess whether the addition of morphine to unilateral periarticular knee injections improves postoperative pain, range of motion, and swelling in patients undergoing simultaneous bilateral TKA.

The Efficacy of Periarticular Multimodal Drug Injection for Postoperative Pain Management in Total Knee or Hip Arthroplasty

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.     

Effect of Periarticular Morphine Injection for Total Knee Arthroplasty: A Randomized,Double-Blind Trial

Background

The periarticular multimodal cocktail injection including morphine is currently commonly used to treat postoperative pain after total knee arthroplasty (TKA). Despite its analgesic effect, it is frequently reported to cause nausea and vomiting, which are adverse effects of opioids. This study aimed to assess the efficacy of morphine as a component of a multimodal cocktail injection for providing postoperative analgesia and alleviating swelling in patients who underwent TKA.

Multimodal Pain Management in Total Knee Arthroplasty : A Prospective Randomized Controlled Trial

We analyze the effects of a multimodal analgesic regimen on postoperative pain, function, adverse effects and satisfaction compared to patient-controlled analgesia (PCA). Thirty-six patients undergoing TKA were randomized to receive either (1) periarticular injection before wound closure (30 cc 0.5% bupivacaine, 10 mg MSO₄, 15 mg ketorolac) and multimodal analgesics (oxycodone, tramadol, ketorolac; narcotics as needed) or (2) hydromorphone PCA. Preoperative and postoperative data were collected for VAS pain scores, time to physical therapy milestones, hospital stay length, patient satisfaction, narcotic consumption and medication-related adverse effects. The multimodal group had lower VAS scores, fewer adverse effects, lower narcotic usage, higher satisfaction scores and earlier times to physical therapy milestones. Multimodal pain management protocol decreases narcotic usage, improves pain scores, increases satisfaction and enhances early recovery.     

Intravenous Acetaminophen in Multimodal Pain Management for Patients Undergoing Total Knee Arthroplasty: A Randomized,Double-Blind,Placebo-Controlled Trial

Background

Although multimodal pain management including periarticular multidrug injection can provide excellent pain relief in the early postoperative period after total knee arthroplasty (TKA), rebounding pain remains an important challenge. A randomized, double-blind, placebo-controlled trial was performed to investigate the efficacy of adding intravenous acetaminophen to multimodal pain management for TKA.

Efficacy of Single-Shot Adductor Canal Block Combined With Posterior Capsular Infiltration on Postoperative Pain and Functional Outcome After Total Knee Arthroplasty: A Prospective,Double-Blind,Randomized Controlled Study

BackgroundAdductor canal block (ACB) may preserve muscle strength and promote faster recovery than other methods of analgesia following total knee arthroplasty (TKA). However, there are contradictory reports on the efficacy of ACB. Here, we evaluated the efficacy of single-shot ACB combined with posterior capsular infiltration (PCI) vs multimodal periarticular infiltration analgesia in treating postoperative pain.MethodsThis study involved patients undergoing unilateral primary TKA at our institution from January 2018 to January 2019. Patients were randomized into 2 groups, one of which was treated with ACB combined with PCI, and the other with periarticular infiltration analgesia. Primary outcomes included postoperative pain as assessed by the visual analog scale (VAS) and consumption of morphine hydrochloride. The secondary outcome was functional recovery, as assessed by range of knee motion, quadriceps strength, and daily ambulation distance. Tertiary outcomes included the duration of hospital stay and postoperative adverse effects.ResultsPatients treated with ACB and PCI had lower resting VAS scores at 8 and 24 hours after surgery, and lower VAS scores during motion within 48 hours after surgery. Patients treated with ACB and PCI also consumed less morphine. There was no difference in functional recovery, duration of hospitalization, or incidence of adverse events.ConclusionThe ACB combined with PCI can reduce postoperative pain sooner after TKA without affecting postoperative functional recovery and increasing complications.