膝关节单髁置换术中关节周围注射镇痛混合剂的应用研究

Application of intraoperative periarticular injection of cocktail analgesics in unicompartmental knee arthroplasty

目的探讨膝关节单髁置换术(UKA)中关节周围浸润注射"鸡尾酒"式镇痛混合剂的临床应用效果。方法将拟接受UKA的46例患者随机分成两组,23例术中关节周围浸润注射镇痛混合剂[吗啡5 mg,盐酸罗哌卡因注射液(施乐品)75 mg,复方倍他米松注射液(得宝松)1 ml,1∶10 000肾上腺素1 ml,加入生理盐水稀释至20 ml],其余23例注射生理盐水进行对照。评估并记录各患者手术前后静息和活动状态下的关节疼痛程度(VAS评分)、主动关节活动范围(ROM),以及术后吗啡使用量、不良反应发生情况,并将两组进行比较。结果镇痛混合剂注射组在术后36 h内的静息和活动VAS评分均明显低于对照组(P<0.05),且术后48 h内的各时间段的吗啡使用量均低于对照组(P<0.05)。镇痛混合剂注射组在术后24 h、48 h镇痛混合剂注射组的主动ROM值均大于对照组(P<0.05),而术后14 d、90 d两组间的主动ROM值差异无统计学意义(P>0.05)。两组的不良反应发生率差别无统计学意义(P>0.05)。结论在UKA术中使用"鸡尾酒"式镇痛药物进行局部浸润镇痛注射,能在术后早期达到较好的疼痛控制,有效减少术后吗啡的使用,使患者早期获得较大的关节活动度,临床应用较为安全有效。

Objective To evaluate the clinical efficacy and safety of the cocktail analgesics injection during unicompartmental knee arthroplasty（UKA）.Methods Forty-six patients undergoing UKA were randomized into two groups averagely in a double-blind way.In the treatment group,an analgesic mixture of morphine,ropivacaine,betamethasone and epinephrine was infiltrated intraoperatively into the soft tissue,while in the control group,a same volume of normal saline was injected alternatively.The perioperative visual analog score（VAS） of each patient in both rest and active states was measured and recorded,as well as the voluntary rang of motion（ROM）,morphine consumption and adverse effects following UKA.A comparison of the above-mentioned indicators was held between the two groups.Results The VAS scores of both rest and active states in the treatment group were statistically significantly lower than those in the control group（P〈0.05） within 36 h postoperatively,so as the morphine consumption（P〈0.05） in each time period within 48 h after UKA.In the treatment group,the voluntary ROM was statistically significantly higher than that in the control group（P〈0.05） at 24 h and 48 h after the surgery,but the voluntary ROM differences between the two groups were not statistically significant on the14^ thday and the 90^ thday postoperatively（P〉0.05）.The incidences of the adverse effects following the surgery in the two groups were not statistically different（P〉0.05）.Conclusion The application of the cocktail analgesics injection during UKA could provide effective pain control early after the surgery,and reduce morphine consumption as well as improving the joint range of motion during the early postoperative period,which would be beneficial to the recovery of patients.