摘要
目的比较关节局部注射混合局麻药与自控硬膜外镇痛(PCEA)对全膝关节置换(TKA)术后的镇痛效果。方法由同一位医师主刀完成的TKA骨性关节炎(OA)患者58例(63膝),根据镇痛方式分成两组:局部注射组23例(25膝),术中关节周围软组织注射2.5g/L布比卡因40ml、酮咯酸30mg和肾上腺素0.25mg的混合液,术后拔除引流管时通过关节腔内放置的细导管注射5g/L布比卡因20ml和酮咯酸30mg。35例(38膝)TKA术后采用PCEA做为对照,比较术后两种镇痛方式的疼痛视觉模拟评分(VAS)、吗啡的使用量、关节被动活动度(PROM)、切口引流量和恶心、呕吐的发生率。结果两组术后的VAS和PROM差异无统计学意义(P>0.05),而局部注射组术后吗啡使用量、切口引流量和恶心、呕吐的发生率明显减少(P<0.05)。结论关节周围软组织和关节内注射混合局麻药对TKA术后的镇痛效果确切,减少了术后出血量、吗啡的使用量和并发症,成本低,且操作简便、实用,是TKA镇痛的有效方法之一。
Objective To investigate the analgesic effect of a multimodal drugs injection locally around TKA in retrospective comparison with patient-controlled epidural analgesia （PCEA）.Methods A total of 58 OA patients （63 knees） who were performed total knee arthroplasty （TKA） by the same orthopedist were divided into two groups by analgesic methods. The study group of 23 patients （25 knees） received intraoperative injection of 40 ml 2.5 g/L bupivacaine,30 mg ketorolac and 0.25 mg epinephrine into the periarticular soft tissues,and 20 ml 5 g/L bupivacaine with 30 mg ketorolac into articular capsule through a slender catheter as the drainage tube drawn after operation. A control group of 35 patients （38 knees） received PCEA after the surgery.The postoperative visual analog scores （VAS）,morphine usage,passive range of motion （PROM）,drainage volume of incision and the incidence of nausea with emesia were examined and compared between two groups.Results There were not significant difference in VAS and PROM between two groups（P〉0.05）,but periarticular and intra-articular injection of a multimodal drugs of the study group decreased significantly morphine usage,drainage volume and the incidence of nausea with emesia in the postoperative period（P〈0.05）.Conclusions Periarticular soft tissues and intraarticular injection with multimodal drugs has good analgesia for TKA,reduces blood loss and the requirements for morphine. This simple,inexpensive method provides an effective adjunct to a multimodal approach in improving the postoperative course of primary TKA.
出处
《临床骨科杂志》
2009年第4期374-377,共4页
Journal of Clinical Orthopaedics
关键词
关节成形术
置换
膝
镇痛
手术后
麻醉
局部
麻醉药
局部
arthroplasty, replacement, knee
analgesia, postoperative
anesthesia, local
anesthetics, local
