氟比洛芬酯对膝关节置换术后急、慢性疼痛及关节功能康复的影响

Effects of Flurbiprofen Axetil on acute and chronic postoperative pain and knee rehabilitation after total knee arthroplasty

目的观察全膝关节置换手术(total knee arthroplasty,TKA)围术期应用氟比洛芬酯联合术后持续股神经阻滞(continuous femoral nerve block,CFNB)对患者术后急、慢性疼痛及关节功能康复的影响。方法纳入拟行初次TKA手术的患者90例,随机分为2组:对照组(n=43)和研究组(n=47)。研究组分别于麻醉诱导后、术后6 h及术后24 h静脉注射氟比洛芬酯50 mg;对照组于相应时间点给与等容量生理盐水。两组患者术后均行罗哌卡因CFNB镇痛至术后48 h。观察两组患者术后2 h、4h、8h、24 h、48 h静息及运动状态下疼痛视觉模拟评分(visual analogue score,VAS)、观察术后3个月、术后6个月慢性疼痛患病率、疼痛程度及膝关节主动屈曲角度。结果研究组术后各时间点运动状态疼痛VAS评分低于对照组(P<0.01);研究组术后4 h、8 h静息状态VAS评分低于对照组(P<0.01)。术后3月慢性疼痛患病率研究组为12.8%(6/47)低于对照组(30.2%,13/43),研究组慢性疼痛患者NRS评分为2.49±0.61,低于对照组患者评分(3.43±0.35)(P<0.05);术后3个月研究组术侧膝关节主动屈曲角度为102.4°±16.3°,高于对照组患者(90.9°±20.1°)(P<0.01)。术后6个月时两组患者慢性疼痛患病率及膝关节主动屈曲角度组间差异无统计学意义。结论围术期应用氟比洛芬酯可优化TKA术后CFNB镇痛效果,并降低术后慢性疼痛发生率,促进术后膝关节功能康复,具有良好的安全性。

Objective： To investigate the effects of flurbiprofen axtil on acute and chronic postoperative pain and knee rehabilitation in patients, who underwent total knee arthroplasty（TKA） in perioperative period combined with continuous nerve block（CFNB）. Method：Totally, 90 patients were performed primary total knee arthroplasty（TKA） randomly assigned to control group（n=43）, and study group（n=47）. In study group, a 500 mg dose of flurbiprofen axetil was given by injection into patient＇s vein after anesthesia induction, 6, 24 hours postoperatively. The control group was given the same amount of saline at the corresponding time points. Continuous femoral nerve block（CFNB） was performed in the two groups by ropivacaine for analgesia until 48 hours postoperatively. Observing the visual analog scales（VAS） at resting and activity within 2, 4, 8, 24, 48 hours, including various the prevalence of chronic pain, the level of pain, and the angle of knee joint flexion after 3, 6 months. Results： After surgery, comparison with control groups, the visual analog scales of activity in study group was lower during motion state within different time point and resting state within 4,8 hours（p0.01）.Three months later, the prevalence of chronic pain in study group was lower than in control group [12.8%（6/47） vs. 30.2%（13/43）]. The NRS score of chronic pain in study group（2.49±0.61） was lower than in control group（3.43±0.35）（P〈0.05）. The angle of knee joint flexion in study group（102.4° ±16.3°） was higher than in test group（90.9° ±20.1°）（P〈0.01）. After six months, there was no significant difference in the prevalence of chronic pain, and the angle of knee joint flexion between the two groups. Conclusions： Application of Flurbiprofen Axetil can be used to improve the analgesic effect of CFNB after total knee arthroplasty in perioperative period, reduced the rate of chronic pain, and promoted the recovery of knee rehabilitation.