关节内罗比卡因保留灌注在人工膝关节置换术后的镇痛效果

CLINICAL OBSERVATION ON EFFECTS OF RELIEVING PAIN OF ROPIVACAINE INJECTION INTRA-ARTICULAR POST-TOTAL KNEE ARTHROPLASTY

目的:观察人工膝关节置换术(TKA)后膝关节内罗比卡因、肾上腺素及吗啡保留灌注的镇痛效果和不良反应及对关节活动度(ROM)的影响,以评价其镇痛作用的有效性、安全性,并进一步探讨对关节功能恢复有无帮助。方法:选择准备行单侧TKA患者72例,随机分成两组,每组36例。对照组手术结束前关节内不进行药物保留灌注,干预组手术结束前关节内给罗比卡因、肾上腺素及吗啡保留灌注,其余干预措施均相同。采用视觉模拟评分(VAS)评价其镇痛效果,同时对关节活动度(ROM)及不良反应情况进行观察。结果:麻醉苏醒后,干预组VAS评分明显低于对照组,差异有统计学意义(t=2.749,P<0.01);术后4小时,干预组VAS评分也低于对照组,差异有统计学意义(t=2.149,P<0.05);术后24小时及术后48小时,干预组VAS评分仍低于对照组,但是差异无统计学意义。麻醉苏醒后,对照组75%的患者(27/36)需接受镇痛补救,干预组39%的患者(14/36)需接受镇痛补救,两者差异有统计学意义(χ2=9.57,P<0.01)。术后关节活动达到90°的天数,干预组短于对照组,差异有统计学意义(t=2.886,P<0.01)。经6个月随访,ROM干预组明显优于对照组,差异有统计学意义(t=2.506,P<0.05)。术后2天内,两组不良反应发生率无显著性差异。结论:膝关节内罗比卡因、肾上腺素及吗啡保留灌注,对TKA后患者短期镇痛效果显著,能促进关节功能恢复且不良反应发生率低。

Objective:To observe effects of relieving pain and adverse reactions of Ropivacaine,epinephrine and morphine intra-articular injection post-total knee arthroplasty(TKA),and influence of them on joint range of motion(ROM),appraise the availability and safe of their analgesic effect and approach actions of them on recovery of joint function.Methods:72 cases of patients ready for TKA on single side,were randomly divided into two groups,group A(Ropivacaine,epinephrine and morphine intra-articular injection post-operation) and group B(nothing was given),36 cases in each group,intervention studies were performed on them.Analgesia effect of them were evaluated by visual analogue scale(VAS),and ROM and adverse reactions were observed.Results:Recovery after anesthesia,score of VAS in group A was obviously lower than that in group B,and there had much significant discrepancy(t = 2.749,P < 0.01).4 hours post-operation,the same were the scores of VAS,and there had significant sense on discrepancy(t = 2.149,P < 0.05).24 hours and 48 hours later,the scores of VAS were too,and there had no significant discrepancy.On remedy of relieving pain,the number of group A was 14(39%),but that of group B was 27(75%),there had significant discrepancy(X2 = 9.57,P < 0.01).On day numbers of degrees of joint motion reached to 90? it of group A was shorter than that of group B,there had much significant sense on discrepancy(t = 2.886,P < 0.01).After six-month follow-up visit,group A was super to group B on ROM,and there had significant discrepancy(t = 2.506,P < 0.05).There had no significant difference on incidence rate of adverse reactions in two groups during 2 days post-operation.Conclusion:The method above had obviously short-term analgesia effect on patients of TKA,and could promote recovery of Joint function and degrade incidence rate of adverse reactions.