多模式镇痛治疗人工全膝关节置换术后疼痛及非甾体类抗生素使用量的临床研究

Efficacy of multimodal perioperative analgesia protocol with periarticular medication injection and dosage of non-steroidal anti-inflammatory drugs in total knee arthroplasty

目的研究多模式镇痛镇痛效果与非甾体类抗生素在围手术期的使用情况。方法根据纳入及排除标准选取2012年9月1日至2015年11月1日在西安交通大学第二附属医院行单侧全膝关节置换术(TKA)的患者110例,所有患者均诊断为骨关节炎(OA)。所有患者采用随机数字表法分为两组,各55例患者。实验组给予非甾体类抗生素按需给药联合多模式镇痛治疗组(罗哌卡因注射液200 mg、酮洛酸氨丁三醇30 mg、地塞米松5 mg、肾上腺素0.3 mg),对照组给予非甾体类抗生素按需镇痛。两组均于术后2 d采用镇痛泵恒定速率镇痛,记录患者术后数字分级法疼痛评分(NRS),术后关节活动度与西大略湖和麦克马斯特大学(WOMAC)骨关节炎指数评分,以及住院时间、患者满意度、及非甾体类抗生素使用剂量。计数资料采用卡方检验,计量资料采用独立样本t检验进行统计学分析。结果实验组术后运动的NRS与对照组比较差异存在统计学意义(P<0.05),术后静息NRS与对照组比较差异存在统计学意义(P<0.05)。实验组膝关节活动度在12、24、48、72 h与4 d时与对照组比较存在统计学差异。结论 TKA患者应用多模式镇痛疗法可以减轻患者术后早期疼痛,改善关节活动度,提前患者康复锻炼时间,有利于患者康复,提高患者满意度,且未发现明显副作用。

Objective To explore the multimodal analgesia and the usage of nonsteroidal antiinflammatory drugs（ NSAIDS） for early analgesic effect and rehabilitation after total knee replacement（ TKA）. Methods According to inclusion and exclusion criteria,110 eligible patients who were scheduled to undergo primary TKA for osteoarthritis from September 1st,2012 to November 1st,2015 were selected.All the patients were diagnosed as osteoarthritis（ OA） and were divided into two groups by random digital table method,55 cases each. The experimental group received a periarticular multimodal drug injection containing 200 mg ropivacaine,30 mg ketorolac tromethamine,0. 3 mg epinephrine and 5 mg hexadecadrol during surgery. The control group received an equal volume of normal saline. All the patients received an analgesia pump and moderate nonsteroidal anti-inflammatory drugs（ NSAIDs）. Resting and motion numeric rating scales（ NRS） scores,knee joint range of motion,length of postoperative hospital stay,the Western Ontarioand Mc Master universities（ WOMAC） osteoarthritis index score,patient satisfaction,total NSAID consumption and side effects were recorded. Results The experimental group exhibited significant improvement in pain NRS scores during rest and exercise several days postoperatively（ P〈0. 05）. The range of joint motion was more flexible in the experimental group（ P〈0. 05） at 12、24、48、72 h and 4 d compared with the control group,and the length of postoperative hospital stay was shorter（ P〈0. 05）.Patients in the experimental group consumed fewer NSAIDs and reported greater satisfaction with the surgery（ P〈0. 05）. Conclusion Intraoperative periarticular injection with multimodal drugs significantly may relieve pain after the surgery and reduce the requirements for NSAIDs; this injection also improves patient satisfaction and the range of joint motion with no apparent risks following TKA.