全膝关节置换术中关节周围镇痛的应用研究

目的 观察关节周围注射复方镇痛药在全膝关节置换术(TKA)术中的应用价值.方法 选择2007年3至6月间完成的TKA骨性关节炎(OA)患者36例(36膝)被前瞻性随机分为两组:注射组(A组,17例)和非注射组(B组,19例).A组术中于关节及切口周围浸润注射(罗哌卡因200 mg+吗啡5 mg+1:1000肾上腺素0.3 ml+生理盐水)100 ml复方镇痛注射液.B组不注射,术后两组均统一配置自控硬膜外镇痛(PCEA).比较术后两组的疼痛视觉模拟评分(VAS)、开启PCEA的时间和PCEA的麻醉药总用量、关节活动度(ROM)、切口引流量和上消化道等不良事件和术后并发症等情况.结果 A组PCEA开启时间为4～12 h(P50=8),B组为3～6 h(P50=5),两组差异有统计学意义(P＜0.05).A组24 h和总的PCEA麻醉药用量为均少于B组(P＜0.05);术后6 h和12 hVAS评分A组优于B组.两组术前基线资料、伤口引流量、ROM、术后不良事件及并发症情况差异无统计学意义.结论 TKA术中关节周围镇痛可延长PCEA开启时间,减少麻醉药用量和缓解术后早期疼痛,是TKA镇痛的有效方法之一.

Application study of periarticular multimodal drug injection in total knee arthroplasty

Objective To investigate and compare the analgesic effect of a periarticular multimodal drug injection and patient-controlled epidural analgesia (PCEA) in total knee arthroplasty (TKA). Methods Thirty-six patients undergoing unilateral TKA were randomly divided into two groups (A and B). Group A received a periarticular injection of ropivacaine, morphine and epinephrine at operation and Group B did not. All patients received postoperative patient-controlled epidural analgesia (PCEA). Preoperative baseline data, surgery-related conditions, postoperative VAS (visual analog score) , range of motion( ROM), time of opening PCEA, drug dosage in PCEA and side effects were recorded respectively. Results At 6, 12 hour VAS in Group A was lower than Group B ( P ＜ 0. 05 ). The time of opening PCEA in Group A was longer than Group B ( P ＜0. 05 ). The drug dosage in PCEA in Group A was less than Group B ( P ＜0.05 ). There was no difference of surgical conditions, ROM, 24/48 hour VAS and side effects between two groups (P ＞0. 05 ). Conclusion Periarticular drug injection during TKA can relieve pain early after TKA, prolong the time of opening PCEA and reduce the drug dosage in PCEA.