期刊文献+

不同药物配方对全膝关节置换术局部浸润镇痛作用的影响 被引量:4

Efficacy of Different Formula Infiltration Analgesia after Total Knee Arthroplasty
下载PDF
导出
摘要 目的比较局部浸润镇痛不同药物配方对全膝关节置换术患者术后镇痛效果。方法将150例拟行单侧膝关节置换术患者随机分为3组:R组、RF组与RM组,每组50例。3组患者均使用腰麻。R组配方为:罗哌卡因100 mg加生理盐水至50 m L。RF组配方为:罗哌卡因100 mg加芬太尼100μg加生理盐水至50 m L。RM组配方为:罗哌卡因100 mg+甲泼尼龙40 mg加生理盐水至50 m L。术毕连续股神经阻滞镇痛(CFNB)。镇痛不足时由医师根据患者疼痛程度给予肌内注射哌替啶50 mg。记录术后静息状态下4、8、12、16、24、36、48 h的疼痛视觉模拟评分(VAS)和术后24、36、48 h被动功能锻炼时疼痛VAS评分及并发症。结果 3组疼痛VAS评分在静息状态下术后4、8 h时无显著性差异,术后12、24、36和48 h时RM组疼痛VAS评分均比R组和RF组低(P<0.01),而R组与RF组在各个观察时点疼痛VAS评分均无显著性差异。RM组功能锻炼时疼痛VAS评分均比R组和RF组明显低(P<0.01),而R组与RF组无明显差异。R组和RF组在术后静息状态下肌注补充镇痛药哌替啶的药量明显比RM组高(P<0.01)。结论膝关节置换术局部浸润镇痛配方建议使用罗哌卡因联合甲泼尼龙,不建议联合芬太尼。 Objective To compare the analgesic efficacy of different formulas of local infiltration analgesia (LIA) after total knee arthroplasty (TKA). Methods 150 patients undergoing TKA under spinal anesthesia were randomized to three groups:group R (ropivacaine 100 mg dissolved to 50 mL with normal saline), group RF (ropivacaine 100 mg + fentanyl 100 μg dissolved to 50 mL with normal saline) and group RM(ropivacaine 100 mg + methylprednisolone 40 mg dissolved to 50 mL with normal saline). Continuous femoral nerve block (CFNB) was established after spinal anesthesia and 20 mL of 0.5% ropivacaine was infused through the catheter placed near femoral nerve. Adjuvant analgesics were IM pethidine. The pain visual analogue scale (VAS) scores were assessed after operation at 4, 8, 12, 16, 24, 36 and 48 h at rest and after operation at 12, 36 and 48 h on passive mobilization by acute pain service blinded to analgesic treatment. Nausea and vomiting, dizziness and other side-effects were assessed postoperatively. Results The pain VAS scores at rest of three groups were not significantly different 4 and 8 h after surgery. The pain VAS scores of group RM were significantly less than group R and group RF at rest 12, 16, 24, 36 and 48 h after surgery (P <0.01), but there was no significant difference between group R and group RF. A significant difference in pain VAS scores was found in group RM vs. group R and group RF on passive mobilization 24, 36, 48 h after operation (P <0.01), but there was no significant difference between group R and group RF. The postoperative pethidine consumptions of group R and group RF were more than that of group RM (P <0.01)at 48 h after operation. Conclusion CFNB combined with LIA was effective in controlling postoperative pain after TKA. The best formula for LIA was ropivacaine combined methylprednisolone and normal saline, but not combined fentanyl and normal saline.
作者 张大志 张文杰 杨小宇 ZHANG Da-zhi;ZHANG Wen-jie;YANG Xiao-yu(Beijing Jishuitan Hospital, Beijing 100035, China)
机构地区 北京积水潭医院
出处 《中国药物警戒》 2016年第10期627-629,633,共4页 Chinese Journal of Pharmacovigilance
关键词 股神经 局部浸润镇痛 术后镇痛 全膝关节置换 femoral nerve local infiltration analgesia postoperative analgesia total knee arthroplasty
  • 相关文献

参考文献5

二级参考文献48

  • 1蔡垣星,李蕾,孙磊,程庆好,史健,杜平,李宝琴.罗哌卡因复合舒芬太尼对神经丛阻滞效果的影响[J].首都医科大学学报,2009,30(2):252-255. 被引量:15
  • 2Strassels SA,Chen C,Carr DB.Postoperative analgesia:economics,resource use,and patient satisfaction in an urban teaching hospital.Anesth Analg,2002,94:130-137.
  • 3Michael J,David O,Keng L,et al.Continuous Femoral Nerve Blockade or Epidural Analgesia After Total Knee Replacement:a prospective randomized controlled trial.Anesth Analg,2005,101:1824-1829.
  • 4Fowler SJ,Symons J,Sabato S,et al.Epidural analgesia compared with peripheral nerve blockade after major knee surgery:a systematic review and meta-analysis of randomized trials.Br J Anaesth,2008,100:154-164.
  • 5Allen HW,Liu SS,Ware PD,et al.Peripheral nerve blocks improve analgesia after total knee replacement surgery.Anesth Analg,1998,87:93-97.
  • 6Bruce BD,Kevin S,Jacques E.Analgesia after total knee arthroplasty:is continuous sciatic blockade needed in addition to continuous femoral blockade? Anesth Analg,2004,98:747-749.
  • 7中华医学会北京分会麻醉专业委员会.伤口连续渗透罗哌卡因进行术后镇痛.麻醉与监护论坛,2004,11(1):77-78.
  • 8唐帅,洪溪,黄宇光,任洪智,叶铁虎,罗爱伦.罗哌卡因复合舒芬太尼用于腰丛联合坐骨神经阻滞的临床观察[J].临床麻醉学杂志,2007,23(8):654-656. 被引量:14
  • 9庄心良,曾因明,陈伯銮.现代麻醉学[M].3版.北京:人民卫生出版社,2006:2308.
  • 10Essving P, Axelsson K, Elisabeth A, et al. Local Infiltration Analgesia Versus Intrathecal Morphine for Postoperative Pain Management After Total Knee Arthroplasty: A Randomized Cont- rolled Trial[J]. Anesth Analg, 2011,113:926-933.

共引文献91

同被引文献19

引证文献4

二级引证文献33

相关作者

内容加载中请稍等...

相关机构

内容加载中请稍等...

相关主题

内容加载中请稍等...

浏览历史

内容加载中请稍等...
;
使用帮助 返回顶部