全髋关节置换术后改良鸡尾酒疗法的镇痛效果

Analgesic effect of modified cocktail therapy after total hip arthroplasty

目的探讨改良鸡尾酒疗法关节周围注射对全髋关节置换术后镇痛的疗效。方法选取2015年12月至2017年12月大连大学附属中山医院骨关节科收治的因股骨颈骨折行单侧人工全髋关节置换术的150例患者,将其随机分为改良组(关节置换术联合改良鸡尾酒疗法关节周围浸润注射)、传统组(关节置换术联合罗哌卡因与肾上腺素关节周围浸润注射)和对照组(关节置换术联合等量生理盐水关节周围浸润注射),每组50例。观察比较3组患者术后静态和动态VAS评分、PCIA按压次数、补救性镇痛药物使用量、站立时髋关节屈曲角度以及不良反应发生情况等。结果改良组患者术后6 h、12 h、1 d、2 d、3 d的静态和动态VAS评分均明显低于传统组、对照组,差异有统计学意义(P<0.05),而术后4 d、7 d、14 d静态和动态VAS评分与传统组、对照组比较差异无统计学意义(P>0.05);改良组患者术后2 d内PCIA按压次数、术后补救镇痛药物使用量均明显低于传统组、对照组,差异有统计学意义(P<0.05)。改良组患者3 d、4 d、7 d、14 d站立时的髋关节屈曲角度明显大于传统组、对照组,差异有统计学意义(P<0.05)。术后出现恶心、呕吐症状情况,改良组1例,传统组2例,对照组1例,3组比较差异无统计学意义(P=0.735),且无其他不良反应及并发症。结论在接受全髋关节置换术治疗的患者中,改良鸡尾酒疗法对术后疼痛控制效果显著,可减少患者术后阿片类药物的使用,并可更好地控制疼痛,促进髋关节功能早期恢复,安全性较好。

Objective To study the analgesic effect of modified cocktail periarticular injection on total hip arthroplasty.Methods A total of 150 patients who underwent unilateral total hip arthroplasty for femoral neck fractures in the orthopedics department of Zhongshan hospital affiliated to Dalian university from December 2015 to December 2017 were randomly divided into modified group(joint replacement+modified cocktail therapy,infiltration around the joint),conventional group(joint replacement+ropivacaine and adrenaline infiltration injection),and control group(joint replacement+equivalent saline infiltration injection),with 50 cases in each group.The postoperative dynamic and static VAS scores,the number of PCIA compressions within 48 hours after surgery,the amount of postoperative remedial analgesic drugs,the hip-flexion angle when standing,and the incidence of adverse reactions of the three groups were observed.Results The static and dynamic VAS scores of patients in modified group at 6 hours,12 hours,1 day,2 days,and 3 days after surgery were significantly lower than those in conventional group and control group,the differences were statistically significant(P<0.05),the dynamic and static VAS scores were not significantly different from those of conventional group and control group.The number of PCIA compressions and the amount of postoperative remedial analgesics within 2 days of modified group were significantly lower than those of conventional group and control group,and the differences were statistically significant(P<0.05).The hip flexion angles of patients in modified group at 3 days,4 days,7 days and 14 days were significantly greater than those in conventional group and control group,and the differences were statistically significant(P<0.05).After surgery,nausea and vomiting occurred on 1 case of modified group,2 cases of conventional group,and 1 case of control group.There was no significant difference in adverse reaction between the three groups(P=0.735),and there was no other adverse reaction and complication.Conclusion For patients with total hip arthroplasty,modified cocktail therapy has a significant effect on postoperative pain management,it can reduce the use of postoperative opioids,provide better pain management and promote early hip function recovery,with good security.