全膝关节置换膝关节周围混合药物注射与神经阻滞的镇痛效果比较

摘要

BACKGROUND:Periarticular multimodal drug cocktail injection for pain management after total knee arthroplasty (TKA) has been reported,but there are few studies concerning its effect on the range of motion and volume of drainage postoperative,and difference to nerve block.OBJECTIVE:To compare the analgesic effect of periarticular multimodal drug injection and nerve block in TKA.METHODS:Fifty-eight patients undergoing primary unilateral TKA in the First Affiliated Hospital of Anhui Medical University from 1 June 2016 to 31 October 2016 were randomly assigned to experimental and control groups (n=29 per group),followed by received a periarticular intraoperative injection of a 100 mL mixture containing ropivacaine,epinephrine,morphine,and normal saline,and preoperative combined femoral and sciatic nerve block,respectively.Subsequently,the Visual Analogue Scale scores,and range of motion,volume of drainage,hospitalization time,number of the patients given remedial analgesia and complications were compared between two groups.RESULTS AND CONCLUSION:(1) The Visual Analogue Scale scores at rest in the experimental group were significantly lower than those in the control group at 3 days after surgery (P ＜ 0.05).(2) The Visual Analogue Scale scores on movement in the experimental group were significantly lower than those in the control group at 1,2 and 3 days after surgery (P ＜ 0.05).(3) There were no significant differences in the range of motion,volume of drainage,hospitalization time and number of the patients give remedial analgesia between two groups postoperatively (P ＞ 0.05).(4) None appeared with obvious nausea,vomiting and other complications in the two groups.(5) These results indicate that the analgesic effect of periarticular multimodal drug injection is superior to nerve block,and the former is easy to operate,economical and practical.%背景:目前对于膝关节周围混合药物注射的研究主要集中在术后镇痛方面,较少涉及到术后膝关节活动度及引流量等指标,而且与神经阻滞对比的研究较少.目的:比较膝关节周围注射混合药物与神经阻滞在全膝关节置换中的镇痛作用.方法:纳入于2016-06-01/10-31在安徽医科大学第一附属医院行初次单侧全膝关节置换的患者58例,按镇痛方案分成2组,每组29例.关节注射组全膝关节置换术中在膝关节周围注射混合药物100 mL(罗哌卡因、肾上腺素、吗啡、生理盐水);神经阻滞组于术前行股神经、坐骨神经联合阻滞.比较2组术后疼痛目测类比评分、术后膝关节活动度、术后引流量、术后住院时间、术后补救性镇痛患者的分布情况及不良反应发生情况等.结果与结论:①术后第3天静息性目测类比评分关节注射组较神经阻滞组低,差异有显著性意义(P＜0.05);②术后第1,2,3天运动性目测类比评分关节注射组较神经阻滞组低,差异有显著性意义(P＜0.05);③对于术后关节活动度以及术后引流量,术后住院时间、术后补救性镇痛患者的分布情况2组患者差异无显著性意义(P＞0 05);④2组患者术后均无明显恶心、呕吐等不适反应及并发症发生;⑤结果表明,全膝关节置换膝关节周围注射混合药物的镇痛效果优于神经阻滞,而且关节周围注射操作简单、方便,经济实用.