两种不同镇痛方式对全膝关节置换术后镇痛效果的比较

Comparison of efficacy of postoperative pain control between cocktail periarticular injection and epidural analgesic after total knee arthroplasty

目的比较硬膜外注射与鸡尾酒关节周围注射两种镇痛方式对人工全膝关节置换术患者的术后镇痛效果,以期为全膝关节置换术术后麻醉方法的选择提供临床资料。方法 ASAI-II级行单侧全膝关节置换术患者140例,随机分为鸡尾酒关节周围注射组(P组)和硬膜外镇痛组(E组)。比较术后72 h内各时间点患肢静止与活动状态下患者的视觉模拟疼痛评分(VAS),术后2周内膝关节自主活动度,以及术后出现的不良反应。结果 8名患者因腰麻效果欠佳或过于紧张而辅助使用了镇痛、镇静药,故其观察数据未纳入本研究分析。P组60例,E组72例。术后72h内,静止状态下VAS评分P组明显低于E组(P<0.05),术后第1天、第2天膝关节活动度P组显著好于E组(P<0.05),但P组中短暂性外周神经麻痹发生率高于E组(P<0.05)。结论与硬膜外镇痛相比,鸡尾酒关节周围注射对人工全膝关节置换术后镇痛效果更优,但鸡尾酒关节周围注射时应避免短暂性外周神经麻痹的发生。

Objective To compare the efficacy of postoperative pain control between epidural analgesic and cocktail periarticular injection after total knee arthroplasty and provide clinical materials for the options of anesthesia method after total knee arthroplasty. Methods 140 ASAI-II patients scheduled for total knee arthroplasty were randomly divided into cocktail periarticular injection group （group P） and epidural analgesia group （ group E ）. The VAS pain scale score of the two group at rest and activity during 2 weeks and 72 hours postoperatively were compared and the knee flexion angle and adverse reactions of all the patients were eval- uated. Results The periarticular injection group had a significantly lower area under the curve for pain score at rest （P〈0.01）. In the periarticalar injection group, the mean knee flexion angle was small but signifi- cantly better at postoperative day 1 （ P〈 0.05 ） and postoperative day 2 （ P〈0.05 ） than that in the epidural analgesia group. The incidence of nausea at postoperative day 1 was significantly lower in the periarticular injection group （ P〈0.01 ）. Trasient peroneal nerve palsy was frequently seen in the periarticular injection group. Conclusion Compared with epidural analgesia, cocktail periarticular injection offers better postoperative pain relief, earlier recovery of knee flexion angle, and lower incidence of nausea. Care should be taken to avoid transient paroneal nerve palsy when using periarticular injection.