连续硬膜外阻滞用于全膝关节置换术前超前镇痛临床疗效分析

Evaluation of the effect of preemptive analgesia with continuous epidual anesthesia in total knee arthroplasty

[目的]评价全膝关节置换术前连续硬膜外阻滞的超前镇痛效果。[方法]将54例行单侧膝关节置换术的患者随机分成两组,实验组术前12h硬膜外置管输入罗哌卡因,对照组输入生理盐水,所有患者术中采用全麻,术后48h内硬膜外自控镇痛,比较两组患者术后不同时间点膝关节静息和活动VAS疼痛评分、不良反应发生率、屈膝90°的天数、静脉血栓的发生率、膝关节活动度及术后6个月术膝慢性疼痛发生率。[结果]术后24h内膝关节静息和48h活动VAS疼痛评分、住院期间深部静脉血栓发生率、屈膝达到90°的天数实验组均低于对照组(P<0.05);术后6个月、1年关节活动度试验组高于对照组(P<0.05);术后2d内不良反应发生率、术后6个月术膝慢性疼痛发生率试验组与对照组无差异(P>0.05)。[结论]连续硬膜外阻滞作为全膝关节置换术的超前镇痛方式能减轻术后早期疼痛、降低术后并发症、增加关节活动度且无明显不良反应。

[ Objective] To observe the effect of preemptive analgesia with continuous epidual anesthesia in total knee arthroplasty. [ Methods] Fifty -four patients who were treated in author＇ s hospital were randomly assigned into two groups with 27 patients in each. One group was treated with 0. 125% ropivacaine 2 ml/h through epidual catheter since 12 hours before the operation. The other group was given saline at the same rate. All the patients received general anaesthesia in the operation. The use of patient controlled analgesia （PCA） with epidual anesthesia was initiated 48 hours after operation. PCA was used as a supplement when the patients comldn＇ t bear the pain. The following variations were compared between these two groups ： visual analog score （VAS） , the incidences of complication, deep vein thrombosis （ DVT）, the time of the ability to actively reach 90 degree knee flexion, the range of motion （ROM） and the chronic pain after operation. [ Results] The following variations were statistically significantly lower in ropivacaine group than that in the saline group： VAS, DVT, the time to reach 90 degree knee flextion, while ROM 6 months and 1 year after operation were significant higher. There were no statistically significant differences between groups in the incidence of the side effects during the two days after the operation and the chronic pain for a longer time. [ Conclusion] Preemptive analgesia with continuous epidual anesthesia can alleviate the early stage of the pain after total knee arthroplasty, decrease the incidence of the complication and increase the rang of motion without obvious side effects.