全膝关节置换术围手术期镇痛方案的研究:关节周围组织浸润麻醉与静脉自控镇痛泵的选择

Research of the analgesia in TKA perioperative:the choose between local infiltration analgesia and intravenous self-control analgesia pump

目的研究全膝关节置换术围手术期关节周围组织浸润麻醉与静脉镇痛泵的疗效。方法本次研究共纳入72例患者,随机分为4组。A组:采用关节周围组织浸润麻醉(LIA),B组:采用LIA+静脉镇痛泵,C组:采用静脉镇痛泵,D组:空白对照组。记录各组术后第2日、2周及3个月时运动时疼痛VAS评分及关节活动度;记录患者术后不良反应。结果关节周围组织浸润麻醉可以明显降低患者早期功能锻炼时的疼痛,提高患者早期关节活动度;单用静脉镇痛泵并不能提高患者膝关节活动度、降低活动时的疼痛评分。联合应用LIA、镇痛泵相对于单用LIA并不能增加镇痛效果。结论围手术期应用关节周围组织浸润麻醉可以显著改善患者术后功能锻炼的依从性、增加围手术期及中长期膝关节活动度。

Objective： To observe the curative effect of local infiltration analgesia/intravenous self-control analgesia pump and the combined use of the both. Methods： Seventy-two patients with osteoarthritis undergone total knee arthroplasty were enrolled in. The patients were divided into 4 groups. In the A group, LIA was given, B group were given both LIA and intravenous self-control analgesia pump, C group intravenous self-control analgesia pump only, and neither was given to D group. The range of motion and VAS dates of 2 days, 2 weeks, 3 months were recorded and analyzed. Results： The infd- tration of anesthesia around the joint significantly reduced the pain in the early functional exercise of the patients and im- proved the early joint activity of the patients. The use of intravenous analgesia pump did not improve the knee movement or reduce the pain score. Combined use of LIA and analgesic pump could not increase the analgesic effect. Conclusion：HA used only can improve the patients＇compliance of functional exercise postoperative and improve the ROM postoperative and reduce pain obviously.