布比卡因脂质体局部浸润麻醉在膝关节单髁置换术后镇痛疗效的前瞻性随机对照研究  

Observation of analgesic efficacy of liposomal bupivacaine for local infiltration anesthesia in unicompartmental knee arthroplasty:a prospective randomized controlled study

作　　者：郑善斌 胡虹钰 夏天卫 邵连生 朱家庆 孙家豪 马博闻 张驰宇 黄礼兵[2] 曹逊 陈志远 张超 沈计荣 ZHENG Shanbin;HU Hongyu;XIA Tianwei;SHAO Liansheng;ZHU Jiaqing;SUN Jiahao;MA Bowen;ZHANG Chiyu;HUANG Libing;CAO Xun;CHEN Zhiyuan;ZHANG Chao;SHEN Jirong(Department of Orthopedics,Affiliated Hospital of Nanjing University of Traditional Chinese Medicine,Nanjing Jiangsu,210029,P.R.China;Department of Anesthesiology,Affiliated Hospital of Nanjing University of Traditional Chinese Medicine,Nanjing Jiangsu,210029,P.R.China)

机构地区：[1]南京中医药大学附属医院骨伤科,南京210029 [2]南京中医药大学附属医院麻醉科,南京210029

出　　处：《中国修复重建外科杂志》2024年第12期1458-1465,共8页Chinese Journal of Reparative and Reconstructive Surgery

基　　金：国家自然科学基金面上项目(82274552);江苏省中医药科技发展项目(ZD202315)。

摘　　要：目的采用前瞻性随机对照研究,探究在膝关节单髁置换术(unicompartmental knee arthroplasty,UKA)中使用布比卡因脂质体(liposomal bupivacaine,LB)进行局部浸润麻醉(local infiltration anesthesia,LIA)术后早期镇痛效果。方法2024年1月—7月共80例膝关节骨关节炎(knee osteoarthritis,KOA)患者符合选择标准纳入研究。按随机数字表法以1∶1比例将患者分为LB组和“鸡尾酒”组,每组40例。两组患者性别、年龄、身体质量指数、手术侧别、Kellgren-Lawrence分级及术前美国麻醉医师协会(ASA)分级、西安大略与麦克马斯特大学骨关节炎指数(WOMAC)评分、膝关节活动度等基线资料比较差异均无统计学意义(P>0.05)。两组患者接受LIA及全病程镇痛管理。记录并比较两组手术时间、切口长度、疼痛相关指标[静息以及活动疼痛视觉模拟评分(VAS),口服吗啡总用量、WOMAC评分]、膝关节活动度、术后首次下地时间、住院时间以及术后不良事件。结果两组患者手术时间、切口长度、术后首次下地时间、术后住院时间、口服吗啡总用量及出院前手术满意度和WOMAC评分比较差异均无统计学意义(P>0.05)。术后4、12、24 h“鸡尾酒”组患者静息VAS评分和活动VAS评分均明显低于LB组,术后60、72 h LB组静息VAS评分明显低于“鸡尾酒”组,术后60 h LB组运动VAS评分明显低于“鸡尾酒”组,差异均有统计学意义(P<0.05);其余各时间点两组上述各指标比较差异均无统计学意义(P>0.05)。术后2 d LB组患者睡眠评分高于“鸡尾酒”组(P<0.05);术后当天和术后1 d两组患者睡眠评分比较差异无统计学意义(P>0.05)。两组并发症发生率比较差异无统计学意义(P>0.05)。结论在UKA术中使用LB进行LIA能够较长时间缓解患者术后疼痛,而短效止痛效果较“鸡尾酒”疗法差,对于减少阿片类药物的使用和UKA术后早期功能康复未见显著优势。但LB能减少患者术后睡Objective A prospective randomized controlled study was conducted to investigate the early postoperative analgesic effectiveness of using liposomal bupivacaine(LB)for local infiltration anesthesia(LIA)in unicompartmental knee arthroplasty(UKA).Methods Between January 2024 and July 2024,a total of 80 patients with knee osteoarthritis(KOA)who met the selection criteria were enrolled in the study.Patients were randomly assigned to either the LB group or the“cocktail”group in a 1∶1 ratio using a random number table,with 40 patients in each group.Baseline characteristics,including gender,age,body mass index,operated side,Kellgren-Lawrence grade,and preoperative American Society of Anesthesiologists(ASA)classification,Western Ontario and McMaster Universities Osteoarthritis Index(WOMAC)score,and knee joint range of motion,showed no significant difference between the two groups(P>0.05).Both groups received LIA and comprehensive pain management.The surgical duration,incision length,painrelated indicators[resting and activity visual analogue scale(VAS)scores,total dosage of oral morphine,WOMAC scores],knee joint range of motion,first ambulation time after operation,length of hospital stay,and postoperative adverse events.Results There was no significant difference between the two groups in surgical duration,incision length,first ambulation time after operation,length of hospital stay,total dosage of oral morphine,and pre-discharge satisfaction with surgery and WOMAC scores(P>0.05).At 4,12,and 24 hours after operation,the resting and activity VAS scores in the“cocktail”group were lower than those in the LB group;at 60 and 72 hours postoperatively,the resting VAS scores in the LB group were lower than those in the“cocktail”group,with the activity VAS scores also being lower at 60 hours;all showing significant differences(P<0.05).There was no significant difference in the above indicators between the two groups at other time points(P>0.05).On the second postoperative day,the sleep scores of the LB group were si

关 键 词：膝关节单髁置换术 布比卡因脂质体 “鸡尾酒”疗法 局部浸润麻醉 镇痛效果 随机对照研究 

分 类 号：R614[医药卫生—麻醉学]