地塞米松用于全膝关节置换术中关节周围浸润镇痛的临床研究

A study of Dexamethasone used in periarticular infiltration analgesia for total knee arthroplasty

目的探讨全膝关节置换(TKA)术中关节周围注射的镇痛混合药物中添加小剂量地塞米松对改善患者术后疼痛的有效性及安全性。方法纳入自2014-12—2015-02行TKA的40例单侧膝关节骨性关节炎,随机分为试验组和对照组,每组20例。试验组75 ml生理盐水混合液包含150 mg罗哌卡因、肾上腺素0.1 ml、地塞米松5 mg;对照组不含地塞米松。结果试验组手术时间为(86.3±2.7)min,对照组为(85.5±2.8)min,差异无统计学意义(t=0.212,P=0.836)。试验组与对照组术后6、12、24、48 h的VAS评分比较差异无统计学意义(P>0.05)。试验组1例出现切口中部皮肤坏死,切除坏死皮肤减张缝合后2周拆线,切口愈合。对照组切口均愈合良好,未出现并发症。2组切口并发症发生率比较差异无统计学意义(χ2=0.026,P=0.500)。结论 TKA术中关节周围注射的镇痛混合药物中添加地塞米松并未增加术后切口感染等并发症的发生,但是也无额外改善术后急性期疼痛的效用,因此临床上不建议添加。

Objective To investigate whether small dose of dexamethasone added to analgesia drug which was used to ease postoperative pain by periarticular injection around joints was effective and secure. Methods Forty patients with unilateral osteoarthritis of the knee who were hospitalized from Dec. 2014 to Feb. 2015 were randomly divided into control group and experimental group, 20 patients each. Experimental group, 75 ml saline mixture, containing 150 mg ropivacaine, adrenaline 0.1 ml, dexamethasone 5 mg were used, compared with the control group without dexamethasone. Results Operation time of experimental group was （86.3±2.7）min, the control group was （85.5±2.8）. There was no significant difference（t =0.212, P = 0.836） between two groups. The difference in pain score 6, 12, 24, 48 hours after replacement between two groups was not statistically significant （P 〉0.05）. One patient of experimental group had skin necrosis in central incision. The stitches were taken out 2 weeks after excision of necrotic skin and tension-reduced suture, wound was healed. The incision in control group healed well without complications. There was no significant difference between two groups （X2 =0.026, P=0.500） in the incidence of incision complications. Conclusion The experimental dose dexamethasone does not increase the occurrence of postoperative complications such as infection of incision, however it does not improve acute postoperative pain relief. So it is not recommended to use dexamethasone clinically.