全膝关节置换术围术期多模式联合镇痛的临床应用

Clinical Application of Multi-modality Combined Analgesia in TKA during Perioperative Period

目的探讨多模式镇痛方式在全膝关节置换术(TKA)围术期的临床应用。方法 TKA患者90例按照数字随机方法分为三组,塞来昔布组(A组)、超前镇痛组(B组)和多模式镇痛组(C组),每组30例,A和C组患者术前2d开始口服塞来昔布,B、C两组在手术完成关腔前于后关节囊、内外侧副韧带附着点、骨膜处注射罗哌卡因针200 mg+盐酸吗啡针10 mg+复方倍他米松1 m L+生理盐水稀释至80 m L。三组患者术后均用静脉自控镇痛泵,比较不同时点静息和运动时疼痛VAS评分,对比三组患者膝关节主动屈伸活动度,比较3组患者术后并发症发生例数。结果在相同时点C组静息VAS和动态VAS评分均明显低于A、B两组(P<0.05),关节屈曲到90°时间C组明显短于A、B两组(P<0.05)。结论多模式镇痛应用于TKA术后镇痛效果良好,副作用明显降低,减少了TKA术患者术后疼痛,有利于患者术后早期开展康复训练。

Objective To explore clinical application of multi-modality combined analgesia in total knee arthroplasty（ TKA） during perioperative period. Methods 90 patients with TKA were divided into three groups according to the numerical randomization method： celecoxib group（ Group A）,preemptive analgesia group（ Group B） and multi-modality analgesia group（ Group C）,30 cases in each group. In Group A and Group C,the celecoxib was administered orally 2 days before surgery.The Group B and Group C were injected with ropivacaine 200 mg,morphine hydrochloride 10 mg,compound betamethasone 1 m L and saline 80 m L in the posterior joint capsule,internal and lateral collateral ligament attachment points,and periosteum before closing the cavity when the surgery was finished. The patients in the three groups were treated with intravenously controlled analgesia pump. The VAS scores of resting and exercising were compared at different time points.The activities of flexion and extension of knee joints amd the number of postoperative complications in the three groups were compared.Results At the same time point,the VAS scores of resting and exercising in Group C were significantly lower than those in Group A and Group B（ P〈 0.05）,and the joint flexion to 90° in Group C was significantly shorter than that in Group A and Group B（ P〈 0.05）.Conclusions The multi-modality analgesia has good analgesic effect after TKA,reduced side effects and postoperative pain in TKA patients. It is conducive to postoperative rehabilitation training.