局部浸润罗哌卡因联合静脉镇痛对全膝关节置换术后镇痛及早期康复的影响

Influence of ropivacaine local infiltration analgesia for postoperative analgesia and early rehabilitation in total knee arthroplasty

目的评估伤口单次局部浸润罗哌卡因联合静脉自控镇痛对全膝关节置换(TKA)术后镇痛的效果及术后早期膝关节康复训练的影响。方法选择腰麻下行膝关节置换手术的患者50例,根据镇痛方式分为两组,罗哌卡因组(25例):术毕切口浸润0.25%罗哌卡因20 ml,术后行静脉自控镇痛(PCIA);对照组(25例):术毕切口浸润生理盐水20 ml,术后行PCIA。采用视觉模拟评分法(VAS)评估不同时间点的镇痛效果,不同时间评定术后康复训练依从性、膝关节主动活动度(ROM)、膝关节功能。结果术后4、6、8、12 h VAS评分:罗哌卡因组分别为1.28分±1.03分、2.17分±1.67分、2.13分±1.76分、2.38分±0.34分,对照组分别为2.75分±1.09分、3.25分±1.29分、4.50分±1.51分、4.62分±1.60分,两组比较差异有统计学意义(P<0.01)。术后24、48 h VAS评分:罗哌卡因组分别为3.20分±1.21分、3.17分±0.84分,对照组分别为3.28分±1.21分、3.56分±1.19分,两组比较差异无统计学意义(P>0.05)。罗哌卡因组与对照组术后康复训练依从性、膝关节ROM及HSS评分比较差异均有统计学意义(P<0.01)。结论应用罗哌卡因局部浸润联合PCIA用于TKA术后镇痛是一种安全有效的镇痛方法,有利于膝关节术后功能的恢复,具有较好的临床应用价值。

Objective To assess single ropivacaine local infiltration for postoperative analgesia and early postoperative rehabilitation in total knee arthroplasty （TKA ）.Methods Fifty patients with TKA were divided into two equal groups;Ropivacaine group （25 cases）：surgery incision infiltration 0.25% ropivacaine 20 ml,and postoperative in-travenous analgesia（PCIA）;Control group （25 cases）：invasive surgery incision saline 20 ml,and PCIA.Visual ana-log scale（VAS）assessed at different time points using the analgesic effect,assessed at different times after rehabilita-tion training compliance,active knee ROM and knee function.Results At postoperative 4,6,8,12h VAS scores of ropivacaine group were 1.28 ±1.03,2.17 ±1.67,2.13 ±1.76,2.38 ±0.34;Control group were 2.75 ±1.09, 3.25 ±1.29,4.50 ±1.51,4.62 ±1.60,differences were statistically significant （P〈0.01）,but differences were not statistically significant postoperative 24,48 h （P〉0.05）：ropivacaine group were 3.20 ±1.21,3.17 ±0.84;control group were 3.28 ±1.21,3.56 ±1.19.Ropivacaine group and the control group after rehabilitation training compliance,knee ROM and HSS scores were statistically significant differences （P〈0.01 ）.Conclusions Ropiva-caine local infiltration combined with PCIA for analgesia after TKA is a safe and effective method.