混合药物关节腔周围注射对人工全膝关节置换术后镇痛疗效的前瞻性研究

The observation of analgesic effect after injection of mixed drug for total knee arthroplasty

目的观察人工全膝关节置换术中予盐酸罗哌卡因、吗啡、肾上腺素混合药物关节腔周围注射的术后镇痛效果。方法前瞻性研究,将2015年5月至2017年12月首都医科大学大兴医院收治的接受单侧全膝关节置换术的96例患者采用随机数字表法随机分为对照组和观察组,每组各48例,术前及术后两组给予相同镇痛方案:术前1 d予盐酸曲马多缓释片口服镇痛,术后3 d予盐酸曲马多注射液肌肉注射镇痛,必要时追加口服盐酸曲马多缓释片口服镇痛;术中两组给予不同镇痛方案:观察组给予混合药物关节腔周围注射,对照组给予等量生理盐水关节腔周围注射。记录指标:(1)术后4 h、8 h、12 h、24 h、48 h、4 d、7 d静息状态下VAS评分;(2)术后24 h、48 h、72 h、4 d、7 d最大膝关节活动度(ROM)状态下的视觉模拟评分(VAS);(3)围手术期不良反应;(4)术后24 h、48 h、72 h追加盐酸曲马多缓释片用量。结果观察组患者在术后4 h、8 h、12 h、24 h、48 h静息状态下VAS评分分别为3.28±2.74分、4.01±2.26分、5.71±1.34分、5.97±2.12分、5.01±1.86分,低于对照组(分别为6.38±2.47分、6.62±3.12分、7.13±2.65分、7.43±1.45分、7.22±1.11分),差异均有统计学意义(P<0.05);观察组患者在术后24 h、48 h、72 h最大ROM状态下的VAS评分分别为5.72±2.02分、5.39±1.78分、5.48±2.10分,低于对照组(分别为7.44±1.55分、7.21±1.03分、6.45±1.32分),差异均有统计学意义(P<0.05);术后4 d、7 d静息状态、最大ROM状态下两组患者间VAS评分差异无统计学意义(P>0.05);观察组术后24 h、48 h追加镇痛药物剂量分别为122±31 mg、154±26 mg,低于对照组(分别为217±64 mg、225±72 mg),差异均有统计学意义(P<0.05);观察组患者术后恶心、呕吐发生率(6.3%)明显低于对照组(22.9%),差异具有统计学意义(P<0.05);两组患者均未发生伤口、心脏等并发症。结论盐酸罗哌卡因、吗啡、肾上腺素混合药物关节腔周围注射能有效缓解全膝关节置换术后早期疼痛,减少术后镇痛药物用量及术后并发症,无明显不良反应。

Objective To observe the postoperative analgesic effect of the injection of ropivacaine hydrochloride,morphine and epinephrine in total knee arthroplasty. Methods From May 2015 to December 2017,96 patients accepted unilateral total knee replacement were randomly divided into control group and observation group,48 cases in each group. The two groups of patients were preoperatively and postoperatively given the same analgesic solution： preoperative 1 d with tramadol hydrochloride zyban analgesia,postoperative 3 d with tramadol hydrochloride injection intramuscular analgesia,if necessary,additional oral tramadol hydrochloride zyban analgesia was given. The two groups were given different analgesic schemes during operation： the observation group was given the injection of the mixed drug joint cavity,and the control group was injected with the same amount of normal saline joint cavity. The visual analogizing score（ VAS） were recorded in the resting state of 4 h,8 h,12 h,24 h,48 h,4 and 7 d. The visual analogizing score（ VAS） of the maximum knee motion（ ROM） of 24 h,48 h,72 h,4 and 7 d after surgery,and the adverse reaction during perioperative period were recorded. The dosage of the sustained release tablets was increased by 24 h,48 hand 72 h after operation. Results At 4 h,8 h,12 h,24 h,and 48 h,the VAS scores in the observation group were 3. 28 ± 2. 74,4. 01 ± 2. 26,5. 71 ±1. 34,5. 97 ± 2. 12 and 5. 01 ± 1. 86 with significant difference（ P〈0. 05）. The VAS scores of the patients in the 24 h,48 h,and 72 h after the operation were 5. 72 ± 2. 02,5. 39 ± 1. 78 and 5. 48 ± 2. 10,respectively,lower than those in the control group（ 7. 44 ± 1. 55,7. 21 ± 1. 03 and 6. 45 ± 1. 32）,the difference was statistically significant（ P〈0. 05）. There was no significant difference in VAS score between the two groups in the maximum ROM state（ P〈0. 05）. The dosage of 24 h and 48 h after operation was 122 ± 31 mg and 154 ± 26 mg in the observation group,which was lower than that of the control group（ 217 ± 64 mg and 225 ± 225 respectively）,and the difference was statistically significant（ P〈0. 05）. The incidence of vomiting（ 6. 3%） was significantly lower than that of the control group（ 22. 9%）,and the difference was statistically significant（ P〈0. 05）. No complications such as wound and heart were found in the two groups. Conclusion Periarticular mixed drug injection can effectively relieve the early postoperative pain,reduce the dosage of postoperative analgesic drugs and postoperative side effects,and there was no obvious adverse reaction.