关节局部注射罗哌卡因结合静脉PCA泵对全膝关节置换术后的镇痛研究

目的研究全膝关节置换术后关节周围注射罗哌卡因结合PCA泵的镇痛效果。方法选取择期行全膝关节置换手术患者90例，随机分为3组，每组30例（n=30），第一组（A组）术后包括膝关节后关节囊和前侧切口周围组织浸润注射罗哌卡因，结合静脉PCA泵镇痛；第二组（B组）术后仅在前侧切口周围组织浸润注射罗哌卡因，而不注射后关节囊，结合静脉PCA泵镇痛。第三组（C组）术后仅采用静脉PCA泵镇痛。分别在术后2、12、24、48、72小时，以视觉模拟量表（visual analogue scale，VAS）评估患者术后的疼痛水平。结果术后2、12、24、48、72小时A、B、C组评分分别为2．0，2．1，4．9；2．7，2．6，5．5；3．5，3．4，4．6；2．4，2．5，3．8；1．4，1．4，2．8。A组和B组评分差异无统计学意义（P〉0．05），A组和B组评分较C组差异有统计学意义（P〈0．05）。结论全膝关节置换术后应用罗哌卡因和静脉PCA泵能够有效缓解疼痛，后关节囊可不注射，镇痛效果优于单用PCA泵。

Local joint injection in combination with PCA pump for total knee arthroplasty analgesia research

Objective To observe the analgesic effects of postoperative periarticular injection and PCA pump after total knee arthroplasty. Methods 90 patients were randomize to three groups. The patients in group A （n=30） receive periarticular injection and Venous PCA pump include the posterior capsule. The patients in group B （n=30） receive periarticular injection and Venous PCA pump exclude the posterior capsule. The patients in group C （n=30） receive Venous PCA pump only. Analgesic efficiency was evaluated by visual analogue scale （VAS） 2,8,24,48,72 hours after the Operation. Results There was no statistical difference in VAS among group A and group B. VAS were lower in the groups A and B than in group C （P〈0.05）. Conclusion After 2,12,24,48,72 hours of A, B, C group was respectively 2.0,2.1,4,9; 2.7,2.6,5.5; 3.5,3.4,4.6; 2.4,2.5,3.8; 1.4,1.4,2.8. Postoperative periarticular injection and PCA pump may provide postoperative analgesia effectively. It can provide superior postoperative analgesia vesus PCA pump.