洛索洛芬在全膝关节置换的围手术期镇痛与术后镇痛中的研究

Controled study of peri-operative analgesia and post-operative analgesia for total knee arthroplasty

目的分析洛索洛芬钠片剂对于全膝关节置换(TKA)术后短期临床效果的影响。方法 2009年1月至2009年12月因膝骨关节炎行单侧全膝关节置换手术患者197例,其中围手术期使用镇痛药物为洛索洛芬和(或)阿片类药物的患者84例。仅使用阿片类药物镇痛的患者为对照组,共27例(男9例,女18例);仅术后使用洛索洛芬镇痛的患者为POST组,共31例(男9例,女22例);术前和术后均使用洛索洛芬的患者为PERI组,共26例(男7例,女19例)。结果三组患者在平均年龄、体重指数、术前患病时间、术前疼痛评分、术前膝关节活动度、术前HSS评分、手术时间、术中止血带时间、术后引流量、术后2周疼痛评分、术后2周活动度、术后2周HSS评分及术后2周行走距离等指标方面无显著差异。但POST组和PERI组阿片类药物使用时长均短于对照组,阿片类药物末次使用时间也早于对照组(P<0.05)。与POST组相比,PERI组洛索洛芬用药总量略少,但无统计学显著意义。结论洛索洛芬联合阿片类药物可有效地控制TKA术后疼痛,达到满意的临床效果。联合用药可减少阿片类药物的用量、缩短阿片类药物的使用时间。洛索洛芬围术期镇痛与术后镇痛相比具有基本相同的临床镇痛效果,但前者的用药量略少。

Objective To evaluate the analgesic effects of loxoprofen sodium in total knee arthroplasty patients. Methods There are totally 197 cases with genoarthritis underwent unilateral total knee arthroplasty in our institute in the year of 2009.84 cases received loxoprofen sodium and/or opioids but no other analgesics for pain management are included in this study.The control group includes 27 cases（9 male,18 female） who only received opioid,the POST group includes 31 cases（9 male,22 female） received loxoprofen sodium and opioid after operation,the PERI group includes 26 cases（7 male,19 female） received loxoprofen before and after operation and received opoid after operation.Results There are no statistically difference between the three groups on age,body weight index,pre - operative illness duration, pre - and post - operative pain score,range of motion,HSS score,neither the operative time,tourniquet time,post -operative drainage and post - operative walking distance.The total duration of opioid usage of POST group and PERI group are significantly shorter than the control group,and the last prescription of opioid of POST group and PERI group are significantly earlier than the control group,P0.05.The total dosage of loxoprofen sodium of PERI group is less than POST group,but not statistically significant.Conclusion Combination of loxoprofen sodium and opioid is an effective strategy for pain management of TKA procedure,and could decrease the dosage and duration of opioid usage.The analgesic effect of peri - operative and post - operative loxoprofen sodium medication are almost equal with a little less dosage required in the prior protocol.