全膝关节置换术围手术期多模式镇痛的临床研究

Multiple-model pain control methods for perioperative pain relief after unilateral total knee arthroplasty

目的探讨围手术期多模式镇痛对全膝关节置换术(TKA)的疗效。方法本组60例患者随机分为三组,每组20例。A组:术后给予静脉镇痛泵(PCIA);B组:术前给予多模式镇痛,术后给予PCIA;C组:围手术期给予多模式镇痛,术后未给予PCIA。记录各组术后吗啡或杜冷丁的用量,静息时疼痛VAS评分;患者满意度,总的疼痛程度及副作用;患者术后2d,14d,6周的被动活动度及术后3个月WOMAC评分。结果(1)B组与C组术后2～8h静息时的疼痛VAS评分、术后24h总的疼痛程度无统计学差别,但显著低于A组;术后24h总的满意度,术后2d,14d被动活动度亦无统计学差别,但优于A组。(2)C组围手术期吗啡所用量明显低于A组和B组。(3)三组术后6周被动活动度、术后3个月WOMAC评分无统计学差异。(4)C组术后并发症的发生率明显低于A组和B组。结论围手术期多模式镇痛能明显减轻TKA术后24h的总疼痛程度,提高总体满意度,术后可以不必用PCIA,能明显改善术后2～14d的关节被动活动范围,增加患者康复的信心。

Objective The goal of this study is to evaluate the method and the effect of muhimodal analgesia during perioperative period. Methods Sixty patients with the diagnosis of osteoarthritis of the knee joint who underwent total knee arthroplasty, were included in this study. They were randomly divided into three groups. Group A patients （n = 20） only received postoperative patient controlled intravenous analgesia （PCIA） ; Group B patients （n = 20） received preoperative multimodal analgesia and received postoperative PCIA; Group C patients （n = 20 ） received periopertive multimodal analgesia but did not receive postoperative PCIA. The consumption of analgesic was measured at different time-points during the twenty-four hours postoperative period. Postoperative visual analog scales （VAS） for pain and satisfaction, the patient gross satisfaction scales （ GSS）, the verhal rating scale scores of the overall pain intensity and all the side effects, functional rehabilitation and scores according to the Western Ontario and McMaster Universities Osteoarthritis Index （WOMAC） were recorded. Results （l） The VAS scores, 2 -8 h for pain at rest, the overall pain intensity were similarly between Group C and Group B （P 〉 0. 05 ）, but significantly lower than Group A ; the GSS and the degree of passive activity 2 and 14 clay after operative were similarly between Group C and Group B （ P 〉 0. 05 ）, but significantly higher than Group A （ P 〈 0. 05 ）. （2） The Group C had a significantly lower consumption of mrophine than that of Group A and Group B. （3） There was no difference in the range of motion six weeks after operation and the WOMAC score three months after operation among the three Groups. （4） The incidence of nausea, vomit and urine retention were lower in Group C than in Group A and Group B （P 〈 0. 05 ）. Conclusions Perioperative muhimodal analgesia can reduce the overall pain intensity, enhance the GSS, make PCA unnecessary and it will reduce the side effects of PCIA. it can improve the range of passive activity 2 - 14 d postoperative, and advance rehabilitation. But the range of passive activity 3 month postoperative and the WOMAC were not different.