全髋关节置换术后多模式镇痛的有效性及安全性

Analgesic effect of multimodal analgesia for unilateral primary total hip arthroplasty.A pilot study

[目的]前瞻性研究多模式镇痛(multimodal analgesia,MA)在全髋关节置换术(total hip arthroplasty,HTA)后镇痛的有效性和安全性。[方法]将60例拟行初次单侧全髋关节置换的患者随机分为2组:多模式镇痛组(MA组)和对照组。所有患者均于术前3 d开始口服塞来昔布(200 mg,2次/d),手术采用静脉、吸入复合麻醉。多模式镇痛组(n=30),于假体安置完成,缝合关节囊后于关节囊周围、切口周围浸润注射罗哌卡因2.5 g/L,80ml(含0.1 mg肾上腺素),逐层关闭切口;对照组(n=30),不做切口浸润直接缝合切口。两组患者均不使用静脉患者自控式镇痛泵。观察2组患者术后1、4、24、48、72 h和出院时的疼痛视觉模拟评分(visual analogue scale,VAS)和术后24、48、72 h及出院时术侧髋关节活动度,阿片类药物使用情况及镇痛相关不良反应发生率。[结果]多模式镇痛组(MA组)患者术后48 h内切口疼痛程度低于对照组,差异有统计学意义(P<0.05),48 h后MA组患者疼痛程度稍低于对照组,但结果差异无统计学意义(P>0.05)。术后髋关节屈伸、外展活动MA组优于对照组,差异有统计学意义(P<0.05);术后24 h内MA组16人要求使用补救性阿片类药物,显著低于对照组(26人)(P<0.05),恶心、呕吐等副反应发生率MA组低于对照组。两组患者均未出现切口感染、下肢深静脉血栓(deep vein thrombosis,DVT)等全髋关节置换术相关严重并发症。[结论]多模式镇痛能有效缓解THA术后疼痛,减少患者对阿片类药物的需求,利于患者术后早期康复的同时不增加THA术后严重并发症的发生率。多模式镇痛是THA术后安全、有效的镇痛方法。

[ Objective ] In this prospective study, we will evaluate the safety and efficacy of multimodal analgesia （MA） in patients undergoing total hip arthreplasty （THA）. [ Method ] In this study, 60 patients scheduled to unilateral primary THA were randomized into two groups ： MA group and the control group. Both of the 2 groups were were given celecoxib 200mg two times a day,3 days preoperatively. The multimodal analgesia group was given local infiltration analgesia （LIA） （ropivacaine 2. 5 g/L,80 ml,with 0.1 mg epinephrine） after closing the joint capsule,the control group didnt have the LIA. All of the patients didnt use the patient-contrelled analgesia. VAS scores were recorded at 1,4,24,48,72 h postoperatively and the day checkout; the hip joint range of motion was measured at 24 h,48 h,72 h postoperatively,the day checkout respectively after surgery, The use of opioids and side effects was also recorded. [ Result] The mean VAS score at each time of MA group was lower than of the control group,but only the dates within 48h postoperation were significant different. The joint range of movement of the MA group was better than of the control group（P 〈0.05）. The control group used more opioids than the MA group,and had a higher rate of vomit and nausea. No serious complications occurred （ such as infection, deep vein thrombosis） in our study. [ Conclusion]The technical MA can relieve pain after the operation,reduce the opioids use and improve the inhabitation but doesnt increase the rate of complications. MA is one of the safe, effective way to control pain after THA.