伤口周围缓释浸润利多卡因控制关节置换术后疼痛的随机对照研究

摘要

目的 探讨伤口周围缓释浸润利多卡因在控制关节置换术后疼痛中的有效性及安全性.方法 将2013年5至10月在北京协和医院骨科由同一位主刀医生完成的全膝关节置换和全髋关节置换病例随机分为两组,一组术后伤口周围持续缓释浸润利多卡因(局部浸润组),一组术后使用静脉镇痛泵输入稀释芬太尼(静脉镇痛组),直至术后48小时.分别记录术后即刻、术后24小时静息、术后24小时运动、术后48小时静息、术后48小时运动视觉模拟评分(visual Ana-logue scale,VAS).对疼痛超过4分或患者自觉疼痛影响休息者给予镇痛药物.比较两组患者的VAS评分、镇痛药物使用量、康复满意率、下肢周径变化、关节活动度、住院时间及并发症发生率.结果 共42例患者纳入研究,男11例,女31例.全膝关节置换25例36膝,全髋关节置换17例19髋.两组患者年龄、性别、身体质量指数、美国麻醉师协会(AmericanSociety of Anesthesiologists,ASA)分级、诊断、手术种类的差异均无统计学意义.局部浸润组术后即刻VAS评分、术后24小时及术后48小时静息VAS评分、阿片类药物用量、并发症发生率均低于静脉镇痛组,两组差异有统计学意义.而两组术后24小时及术后48小时运动VAS评分、康复满意率、下肢周径变化、关节活动度、住院时间的差异均无统计学意义.静脉镇痛组有1例出现伤口脂肪液化,经换药愈合.局部浸润组无伤口并发症.结论 关节置换术后伤口周围持续缓释浸润利多卡因安全有效,对关节置换术后的静息镇痛效果优于静脉镇痛泵、运动镇痛效果与静脉镇痛泵相当,能够明显减少阿片类药物用量.%Objective To evaluate the efficacy and safety of continuous infiltration of Lidocaine in joint replacement surgery.Methods From May 2013 to October 2013,patients scheduled to undergo total hip or total knee arthroplasty were randomized into two groups:the local infiltration analgesia group received continuous infiltration of Lidocaine while the other group received PCIA filled with fentanyl after surgery.The equipments were removed 48 hours after the surgery.The visual analogue scale score at five points (immediate postoperative,24 hours after the surgery while resting,24 hours after the surgery while exercising,48 hours after the surgery while resting,48 hours after the surgery while exercising) were recorded and if the score was higher than 4,analgesics wound be given to the patients.The vital sign,blood test,ECG,the circumference of lower limbs,the range of motion of the joint,the rehabilitation and complications were also recorded.Results 42 patients were included,11 male and 31 female.There were 25 patients and 36 total knee arthroplasties.17 patients underwent a total of 19 hip arthroplasties.The demographic data,the diagnosis and the surgery type were comparable between two groups.The VAS scores at immediate postoperative,24 hours and 48 hours after the surgery while resting,the average dose of analgesics and the complication rate were statistically different be tween two groups.However,the VAS scores at 24 hours after the surgery and 48 hours after the surgery while exercising,the change of the circumferences of the lower limb,the range of motion of the joint,the rehabilitation satisfactory rate and length of stay were comparable between two groups,while no significant difference was observed.One patient in the PCIA group suffered from incision fat liquefaction and healed after three weeks.There were no infection and subcutaneous hydrocele in both groups.Conclusion Continuous infiltration of Lidocaine is more effective than the PCIA while resting after joint replacement surgery and no inferior to it while exercising.It can decrease the amount of Opioid.