目的 评价全髋关节置换术后关节内鸡尾酒式镇痛混合剂注射的镇痛效果和安全性.方法 将80例行单侧全髋关节置换术的骨关节炎患者进行随机分配:试验组行关节内鸡尾酒式镇痛混合剂(包括吗啡、布比卡因、复方倍他米松、肾上腺素)注射,对照组予以生理盐水做对照.所有患者术后48h均接受吗啡自控式静脉镇痛泵镇痛,比较两组患者术后髋关节静息和活动视觉模拟疼痛评分、麻醉剂使用情况、主动直腿抬高时间、屈曲到90°时间、活动度以及并发症.结果 采用关节内鸡尾酒式镇痛混合剂注射后,可以显著减少术后0～36 h各时间段和总的麻醉剂使用量,并推迟术后第一次使用麻醉剂的时间.在术后视觉模拟评分的比较上,静息痛在术后第6、10、24、36 h关节内试验组疼痛评分显著小于对照组,活动痛在术后24、36 h试验组疼痛评分显著小于对照组.患者在可以行主动直腿抬高的时间、髋关节主动活动达90°时间以及术后15d髋关节活动度的比较上,试验组均优于对照组.在术后伤口愈合、感染发生率、血压、心率、皮疹、呼吸抑制和尿潴留的监测上,两组间均无统计学意义,恶心、呕吐发生率试验组小于对照组.结论 关节内鸡尾酒式镇痛混合剂注射有助于减少术后麻醉镇痛剂使用量,减轻术后早期疼痛,有助于患者的早期康复,且没有明显的副作用.%Objective Postoperative pain after total hip arthroplasty(THA) is not well tolerated. We assessed postoperative pain relief and the need for opioid use after using a cocktail of local and intra-articular analgesic injection (LIA) after THA. Methods Eighty patients undergoing THA under spinal anesthesia were randomly assigned to receive either LIA or placebo. The LIA was composed of 5 mg morphine,30 mg bupivacaine (15 mg/1. 5 Ml),l Ml be-tamethasone, and 0. 5 mLepinephrine (1 = 1 000) intraoperatively. We compared three outcomes total morphine consumption, visual analog scale (VAS) at rest and during activity,and hip flexion angle while standing. Results When compared with placebo,opioid consumption was significantly reduced in the trial group,as well as VAS at rest and during mobilization. Earlier rehabilitation and better range of motion (ROM) were achieved in the trial group. There were no significant differences in side effects or postoperative wound healing between groups. Conclusion In patients undergoing THA,LIA may reduce postoperative systemic opioid use and offer better pain control and earlier rehabilitation, without observable risks.
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