全膝关节置换术围手术期多模式镇痛方案的临床研究

目的 比较连续股神经阻滞联合围手术期口服塞来昔布的多模式镇痛方案与单纯患者自控静脉镇痛(patient-controlled intravenous analgesia,PCIA)用于膝关节置换术后镇痛的效果.方法 接受单侧膝关节置换手术患者40例,随机分为两组.一组联合应用围手术期口服塞来昔布及术后连续股神经阻滞的多模式镇痛(联合组,20例),另一组术后单独应用PCIA(PCIA组,20例).两组患者均在全麻下完成手术.联合组患者返病房后即刻及其后每6h经留置的股神经阻滞管注入0.25 s/ml罗哌卡因20ml.PCIA组只连接静脉PCIA装置,芬太尼浓度10μg/ml,每次自控输注2 ml,无背景输注,锁定时间5 min.两组均在术后48 h内记录患者运动及静息状态下的疼痛视觉类比评分(visual analogue scale,VAS),患肢运动阻滞情况及不良反应.并记录术后24、48、72和96h的体温、膝关节屈曲度.结果 术后4 h,联合组患者的VAS显著低于PCIA组(P=0.026);48 h时运动和静止状态下,联合组患者VAS均显著低于PCIA组(P=0.031).术后4h,联合组患者的运动阻滞程度显著高于PCIA组(P＜0.001);术后24、48 h,联合组患者运动阻滞完全消退.联合组患者术后48、72和96 h的体温明显低于PCIA组(P＜0.05).联合组患者术后平均住院时间明显短于PCIA组.结论 膝关节置换术后,低浓度罗哌卡因连续股神经阻滞联合围手术期口服塞来昔布是一种安全有效、镇痛效果良好的多模式镇痛方法.

Multiple-model pain control methods for postoperative pain relief after unilateral total knee arthroplasty

Objective To compare the effects of multiple-model pain control method and fentanyl based patient-controlled intravenous analgesia (PCIA)on patients' recovery after unilateral total knee arthroplasty(TKA).Methods Forty patients suffered unilateral TKA were randomly divided into two groups according to the postoperative pain relief method,group 1 with muhiple-model pain control method and group Ⅱ with fentanyl based PCIA.In group Ⅰ(20 patients),the patients took cerebrex orally during perioperative period and were infused with 20 ml 0f 0.25 g/ml ropivacaine via femoral nerve catheter immediately after surgery and from then on every 6 h postoperatively till 72 h postoperatively.In group Ⅱ(20 patients).fentanyl based PCIA was used as the only postoperative pain relief method.During the first 48 h postoperative ly,visual analogue score(VAS),Bromage scales,temperature,flexion degree of the operated knee joint,postoperative hospitalization time and the incidence of complications were recorded.Results The group Ⅰ had a significant lower VAS at the 4 h postoperatively than group Ⅱ.At the 48 h postoperatively,the VAS of both resting and motion were also lower than that of group Ⅰ.The group Ⅰ had a higher Bromage score until 4 h postoperatively(P＜0.001).In group Ⅰ,the temperatures at 48 h,72 h and 96 h were lower than that of group Ⅱ(P＜0.05).Furthermore,the patients received multiple-model pain control had shorter hospitalization time than the patients received PCIA.Conclusion The multiple-model pain control method provides efficient pain relief after TKA.Postoperative management of pain following TKA can be improved through continuously infusion of 0.25 g/ml ropivacaine via femoral nerve catheter.