全膝关节置换后局部浸润的持续镇痛效果  

Continuous analgesia of local infiltration after total knee arthroplasty

作　　者：陆慧红[1] 李桂凤[1] 白浪[1] 孙继雄[1] 姜桢[1] 尹峰[2] 

机构地区：[1]同济大学附属东方医院麻醉科,上海市200120 [2]同济大学附属东方医院骨科,上海市200120

出　　处：《中国组织工程研究》2014年第4期529-534,共6页Chinese Journal of Tissue Engineering Research

摘　　要：背景:多项研究证实了局部浸润镇痛法的优良镇痛效果,但从文献分析其最佳效果往往限于全膝关节置换后第1天或更短时间内。目的:在全膝关节置换后较低浓度局麻药硬膜外镇痛的基础上应用局部浸润镇痛法,观察静息状态下和运动时的镇痛效果。方法:将全膝关节置换患者分为对照组和局部浸润镇痛组,均给予口服非类固醇抗炎药塞来昔布和置换后低浓度甲磺酸罗哌卡因硬膜外镇痛。2组患者均选择腰硬联合麻醉下行全膝关节置换,置换过程中对照组给予150 mL生理盐水于关节周围注射,局部浸润镇痛组给予同等容量的混合药液,其中包括罗哌卡因300 mg、吗啡5 mg和肾上腺素10μg。采用目测类比评分法评估2组患者置换后6,12,24,36,48 h的静止痛及运动痛,观察置换后恶心、呕吐、下肢麻木感和肌无力感的发生率及严重程度。记录患者置换后切口愈合情况。结果与结论:除置换后48 h的静止痛在2组差异无显著性意义,局部浸润镇痛组患者运动痛、静止痛目测类比评分在各时间点均显著低于对照组(P<0.05),局部浸润镇痛组在6,12 h的静止痛与运动痛差异无显著性意义。患者均未见恶心、呕吐症状,2组各2例患者主诉下肢曾有轻微的麻木感,但并未因肌无力影响功能锻炼。2组切口均为甲级愈合,无切口感染。提示联合口服非类固醇抗炎药和置换后低浓度甲磺酸罗哌卡因硬膜外镇痛,关节周围局部浸润镇痛技术可以在全膝关节置换后提供优良且持续的镇痛效果,且无镇痛相关不良反应出现。BACKGROUND： Accumulating studies have confirmed the excellent effectiveness of local infiltration analgesia, but the literature analysis is mainly limited to within 1 day after total knee arthroplasty or shorter period. OBJECTIVE： To study the effectiveness of local infiltration analgesia （LIA） at low concentration after total knee arthroplasty, and to observe the analgesic effect at rest and movement states. METHODS： Thirty patients undergoing total knee arthroplasty were randomly allocated to control group and LIA group, receiving oral non-steroidal antiinflammatory drug （celebrex） and low concentration of ropivacaine （0.1%） for epidural analgesia. Control group was injected with 0.9% saline 150 mL, while LIA group was injected with equal volume of solution include ropivacaine 300 mg, morphine 5 mg and epinephrine 10 μg. The rest pain and motion pain of patients in two groups were evaluated at 6, 12, 24, 36, 48 hours after operation by using visual analogue scale. The incidence rate and degree of nausea, vomiting, numbness and muscle weakness of the legs were observed after operation. The incision healing was also recorded. RESULTS AND CONCLUSION： Visual analogue scale pain scores in the LIA group were significantly lower than the control group at 6, 12, 24 and 36 hours at rest （P 〈 0.05）, at 6, 12, 24, 36, 48 hours on movement （P 〈 0.05）. At 6 and 12 hours, there was no difference in the rest and motion pains in the LIA groups （P 〉 0.05）. No patient appeared drowsiness, nausea, and vomiting in both groups. Two patients in each group complained of slight numbness in legs. No case influenced function exercise because of muscle weakness. All the wounds healed and there were no incision infections in two groups. Combined with oral non-steroidal anti-inflammatory drug and low concentration of ropivacaine for epidural analgesia, the local infiltration analgesia technique in total knee arthroplasty is effective in early post-operative pain management, and produces no analge

关 键 词：植入物 人工假体 局部浸润镇痛 全膝关节置换 硬膜外镇痛 多模式镇痛 

分 类 号：R318[医药卫生—生物医学工程]