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。

Effect of periarticular multimodal analgesic drug injection on pain control protocol after total knee arthroplasty

Objective To evaluate the effect of periarticular multimodal analgesic drug injection on pain control protocol in total knee arthroplasty （TKA）. Methods Two cohorts of 60 TKA patients were randomly divided into study group （ n = 30 ） and control group （ n =30）. All patients were given celecoxib 24 hours before and the next day after operation 200 mg bid （400 mg orally 6 hours after operation） , paracetamol and tramadol were given a tablet rid orally, and then continuously use for 5 days after operation. Thirty patients of the study group received intraoperative periarticular injection of muhimodal drugs （consisting of 10 g/L ropivacaine 20 ml, morphine 10 rag, compound betamethasone （Diprospan） 1 ml, normal saline 80 ml ） , drug injection around the joint were not used in patients of the control group. Pethidine was used in patients with pain after the first 6 hours, the same dose could be given once again at the same case. Activities and visual analogue pain score were recorded before and after surgery. Results 58 patients involved in the result analysis, of which two cases in the control group had intravenous analgesia after surgery. （ 1 ） visual analogue pain score： the patients of the study group had significantly lower rest pain scores and activity pain scores at hours 6, 12 and 24 after operation than the control group（P 〈 0. 01 ） ; （2） the mean knee ROM of the patients in the study group was obviously larger than that of the control group at 1, 2 and 3 days after operation （P 〈 0. 01 ）. There was no significant differences at 1 and 2 weeks after opration; （3） There were no significant differences in complications such as wound healing, incidence rate of infection, and so on. Conclusions Periartieular injeetion with a multimodal protocol was shown to safely provide excellent pain control and functional recovery. It can reduce visual analogue pain score and improve range of movement after surgery early.