人工全髋关节置换后口服选择性环氧和酶2抑制剂联合罗哌卡因注射的镇痛效果

Analgesic effect of periarticular Ropivacaine infiltration and cyclooxygenase-2 inhibitor following total hip arthroplasty

背景:人工全髋关节置换后的剧烈疼痛是影响患者顺利康复的重要原因之一,如何做到置换后尽可能无痛是目前研究的热点问题。目的:探讨口服选择性环氧和酶2抑制剂联合髋关节周围注射罗哌卡因对人工全髋关节置换后的镇痛效果。方法:单侧初次人工全髋关节置换的骨性关节炎患者40例,随机分为2组,实验组置换前2h口服选择性环氧和酶2抑制剂200mg,人工全髋关节假体安放完毕后在髋关节周围浸润注射0.15%罗哌卡因100mL,置换后采用静脉自控镇痛泵,继续使用选择性环氧和酶2抑制剂10d;对照组仅将罗哌卡因替换为等量生理盐水。结果与结论:与对照组比较,实验组疼痛程度明显减轻,镇痛效果至少维持24h,明显减少静脉自控镇痛泵的用量,且不良反应少。提示口服选择性环氧和酶2抑制剂联合髋关节周围注射罗哌卡因可以有效减轻人工全髋关节患者置换后疼痛,是一种安全的镇痛方法。

BACKGROUND：Severe pain after artificial joint replacement is an important factor for successful rehabilitation.Painless after artificial joint replacement is a hot issue.OBJECTIVE：To explore the effect of cyclooxygenase-2 inhibitor and ropivacaine infiltration analgesia around hip in primary total hip arthroplasty（THA）.METHODS：A total of 40 patients who underwent primary THA were randomized into two groups and received wound infiltration at the end of surgery.Trial group received 200 mg cyclooxygenase-2 inhibitor 2 hours before THA and 0.15% ropivacaine 100 mL following THA,followed by cyclooxygenase-2 inhibitor.Control group were injected with normal saline.All patients used patient-controlled analgesia to reduce pain for 24 hours after THA.RESULTS AND CONCLUSION：The 24-hour patient-controlled analgesia requirement postsurgery was less compared with the control group with less adverse effects.Periarticular intraoperative injection with ropivacaine and cyclooxygenase-2 inhibitor can relieve pain in patients undergoing THA and is a safe analgesia method.