膝关节镜术后吗啡和玻璃酸钠关节内注射镇痛效果的评估

Evaluation of Analgesia Effect With Intra-articular Both Morphine and Hyaluronate After Knee Arthroscopy

目的观察膝关节镜手术后关节腔内应用不同药物镇痛作用的差异。方法60例在硬膜外麻醉下行膝关节镜手术患者,随机分为3组(n=20),术后向关节腔内注入不同的药物。B组:0.375%的布比卡因;M组:2mg吗啡;BMH组:0.375%的布比卡因、吗啡2mg和玻璃酸钠30mg。记录术后第6、12、24、48h患者屈膝关节90°的视觉模拟评分(VAS)、病人满意度和副作用。结果术后第6、12、24、48h患者屈膝90°VAS评分M、BMH组均显著低于B组,BMH组较M组低,统计学差异均有显著性(P<0.05);术后镇痛满意度,M、BMH组较B组高,组间差有显著性(P<0.05);M组有1例恶心,余无其他副作用。结论关节腔内联合注射布比卡因、吗啡和玻璃酸钠可有效缓解膝关节镜术后疼痛,其镇痛效果优于单独应用。

Objective To evaluate the difference in analgesia effects of different regimens used intra - articularly after the knee arthroscopy procedure. Methods Sixty patients performed knee arthroscopy under epidural anesthesia were randomly divided into 3 groups, and the following regimens were injected intra-articularly： the group B, 0.37.5 % bupivacaine; the group M, morphine 2mg; and the group BMH, 0.37.5% bupivacaine, 2mg morphine and 30mg hyaluronate. Visual analog scale （VAS） scores after the patient actively flexed his/her operated knee to 90°, patient satisfaction with analgesic efficacy and the side effect were observed at the 6, 12, 24 and 48 h after operation. Results The 6, 12, 24 and 48 h postoperative VAS scores were much lower in group BMH than in group M and B （P〈0.05）, and VAS in group M was lower than in group B also. Moreover, significant difference in degree of patients satisfaction with analgesic efficacy was observed between group BMH and group M and/or B （P〈0.05）. One case was experienced nausea in group M, no other adverse effects was noted. Conclusion Intra - articular administration of combined bupivacaine, morphine and hyaluronate may provide superior post- operative analgesia vs. bupivacaine or morphine alone. It is an excellent regimen for analgesia after knee arthroscopy.