全髋关节置换后罗哌卡因的镇痛浓度

Concentrations of ropivacaine for analgesia after total hip arthroplasty

背景:全髋关节置换后的剧烈疼痛是影响患者术后关节功能恢复最重要的因素之一,如何做到置换后良好的镇痛是目前研究的热点问题。目的:探讨不同浓度罗哌卡因用于全髋关节置换后的镇痛效果。方法:选取2012年1月至2014年6月于宿迁市人民医院骨外科行全髋关节置换的患者69例,ASA分级Ⅰ-Ⅲ级,采用随机数字表法分为0.25%罗哌卡因组、0.3%罗哌卡因组、0.35%罗哌卡因组,每组23例。置换结束后30 min,行罗哌卡因连续髂筋膜腔隙阻滞,开始各组注入相应浓度的罗哌卡因20 m L,随后接镇痛泵,无背景剂量,自控镇痛剂量为10 m L,时间60 min,持续72 h。于阻滞12,24,48和72 h时记录静息、被动运动和主动运动目测类比评分,静息目测类比评分≥4分时,静脉注射帕瑞昔布钠40 mg。记录阻滞后72 h内罗哌卡因用量、帕瑞昔布钠使用情况、离床时间及不良反应发生情况,同时评价患者镇静情况。结果与结论:与0.25%罗哌卡因组患者比较,0.3%罗哌卡因组和0.35%罗哌卡因组患者静态时目测类比评分差异无显著性意义(P>0.05),被动运动和主动运动目测类比评分均降低(P<0.05),阻滞后72 h内罗哌卡因用量降低;与0.3%罗哌卡因组比较,0.35%罗哌卡因组静态时、被动运动和主动运动目测类比评分比较差异均无显著性意义(P>0.05);0.3%罗哌卡因组和0.35%罗哌卡因组罗哌卡因用量比较差异无显著性意义(P>0.05)。0.3%罗哌卡因组和0.35%罗哌卡因组帕瑞昔布钠使用率显著低于0.25%罗哌卡因组(P<0.05),离床时间短于0.25%罗哌卡因组。并发症发生情况在3组间差异无显著性意义(P>0.05)。提示3组不同浓度的哌罗卡因对全髋关节置换后患者均有一定的镇痛作用,且不良反应较少,其中0.3%的罗哌卡因是全髋关节置换后镇痛的适宜浓度,可减少哌罗卡因的使用量,并缩短患者离床时间。

BACKGROUND：Severe pain after total hip arthroplasty is an important factor for successful rehabilitation of postoperative joint function. Analgesic method after total hip arthroplasty is a hot issue. OBJECTIVE：To investigate the analgesic effect of different concentrations of ropivacaine after total hip arthroplasty. METHODS：69 patients undergoing total hip arthroplasty were recruited from Department of Anesthesiology, Suqian People’s Hospital, from January 2012 to June 2014. According to the ASA classification, their physical status was graded I to III. The involved patients were randomly divided into three groups：0.25%ropivacaine group, 0.3%ropivacaine group, 0.35%ropivacaine group. Each group had 23 cases. At 30 minutes after the surgery, different concentrations of ropivacaine, 20 mL, were injected to patients due to continuous fascia iliaca compartment block. The catheter was then connected to a patient-control ed analgesia pump programmed to deliver 10 mL with a lockout interval of 60 minutes, for postoperative analgesia （72 hours）. At 12, 24, 48 and 72 hours of blockade, the visual analogous scale （VAS） scores at rest, passive and active activity were recorded. When VAS score at rest ≥ 4 points, parecoxib sodium 40 mg was injected intravenously. The consumption of ropivacaine within 72 hours after the blockade, application of parecoxib sodium, time of ambulation, and adverse reactions during blockade were recorded. The analgesic effect in the three groups was also observed. RESULTS AND CONCLUSION：Compared with 0.25%ropivacaine group, static VAS scores of 0.3%ropivacaine group and 0.35%ropivacaine group showed no significant difference （P〉0.05）, passive and active VAS scores were significantly decreased （P0.05）. The ropivacaine consumption of 0.3%ropivacaine group and 0.35%ropivacaine group was not statistical y significant （P〉0.05）. The usage of parecoxib sodium in 0.3%ropivacaine group and 0.35%ropivacaine group was significantly lower than that in 0.25%ropivacaine group （P0.05）. Experimental findings indicate that, three different concentrations of ropivacaine has certain analgesic effects after total hip arthroplasty with fewer adverse reactions, and the concentration of 0.3%ropivacaine is the suitable concentration for postoperative analgesia of total hip arthroplasty, it can reduce the amount of parecoxib sodium and shorten the day of first walk.