帕瑞昔布钠联合关节周围镇痛对全膝置换术后疼痛的影响

EFFICACY OF THE COMBINATION OF PARECOXIB AND PERIARTICULAR MULTIMODAL DRUG INJECTION IN TOTAL KNEE ARTHROPLASTY

目的:研究帕瑞昔布钠超前镇痛联合关节周围镇痛对人工全膝关节置换(total knee arthroplasty,TKA)术后疼痛控制的影响。方法:80个病人随机分为A(帕瑞昔布钠超前镇痛组)、B(关节周围镇痛组)、C(帕瑞昔布钠超前镇痛+关节周围镇痛组)、D(空白对照组)四组,术中通过不同镇痛方法,记录术后视觉模拟(visual analog scores,VAS)评分,术后芬太尼总量以及静脉自控镇痛(patient-controlled analgesia,PCA)按压次数,并比较测量膝关节活动度。结果:C组术后6 h,12 h,24 h,36 h的静止以及运动VAS评分明显低于其它三组;而且C组术后镇痛药物的量明显少于其它三组,术后3天内膝关节活动度明显优于其它三组。结论:帕瑞昔布钠联合关节周围镇痛有利于TKA术后早期控制疼痛、改善关节活动度、促进早期康复。

Objective： To investigate the analgesic efficacy of combination of parecoxib and periarticular multimodal drug injection in patients following total knee arthroplasty （TKA）. Methods： Eighty patients were randomly divided into four groups, Group A （preemptive analgesia with parecoxib）, Group B （ periarticular multimodal drug injection）, Group C （combination of parecoxib and periarticular multimodal drug injection ） , Group D （control group ） , visual analog scores （VAS） for pain, total doses of fentanyl, push numbers for patient-controlled analgesia, and range of motions of the affected knee joint were measured postoperatively. Results： The group C had the lowest VAS scores during rest and active movement at the time of 6, 12, 24, 36 h postoperatively. The group C also had the lowest dose of fentanyl, and achieved the best range of motions in early three days postoperatively. Conclusions： The combination of parecoxib and periarticular multimodal drug injection in patients following TKA could reduce pain and improve range of motion in early stage after operation, thus leading to early rehabilitation.