新型“鸡尾酒”局部浸润镇痛在人工全髋关节置换术后的镇痛效果观察——一项前瞻性随机对照研究

Analgesic effect of a new“cocktail”of local infiltration analgesia after total hip arthroplasty——A prospective randomized controlled study

目的探讨加入得宝松的新型“鸡尾酒”局部浸润镇痛(localinfiltrationanalgesia,LIA)在人工全髋关节置换术(totalhiparthroplasty,THA)后的镇痛效果。方法采用前瞻性随机对照研究,纳入2018年1月—12月四川大学华西医院收治的因髋关节疾病需行单侧初次THA的100例患者,采用随机数字表法分为观察组和对照组,每组50例。两组患者年龄、性别构成、手术侧别、疾病种类、身体质量指数、美国麻醉医师协会(ASA)分级以及术前静息和活动疼痛视觉模拟评分(VAS)、髋关节Harris评分(HHS)、生活质量评定量表(SF-12)评分等一般资料比较差异均无统计学意义(P>0.05)。观察组患者在缝合切口前于髋关节周围使用新型“鸡尾酒”LIA,药物配方为罗哌卡因200mg、得宝松1mL、吗啡10mg,加生理盐水至80mL;对照组不做任何处理。记录两组患者手术时间、术后住院时间、住院期间吗啡用量以及出院时术侧髋关节活动度,并统计并发症发生情况;记录手术前后患者静息和活动状态下术侧髋关节VAS评分、HHS评分和SF-12评分[包括生理评分(PCS)和心理评分(MCS)],并对术后镇痛效果和髋关节功能恢复情况进行患者满意度调查。结果两组患者手术时间比较差异无统计学意义(P>0.05),观察组术后住院时间明显短于对照组(P<0.05)。观察组术后吗啡用量明显少于对照组(P<0.05),住院期间吗啡总用量少于对照组,但差异无统计学意义(P>0.05)。两组患者均随访至术后6个月。观察组术后2、6、12h及术后第1天上、下午静息VAS评分明显低于对照组,术后6、12h及术后第1天上、午活动VAS评分明显低于对照组,差异均有统计学意义(P<0.05);出院当天及术后3、6个月两组静息和活动VAS评分比较差异均无统计学意义(P>0.05)。出院时观察组髋关节屈曲活动度明显大于对照组(P<0.05),但两组髋关节外展活动度比较差异无统计学意义(P>0.05)。术后3、6个月两组患者HHS评分及SF-12评分PCS、MCS差异均无统计学意义(P>0.05)。末次随访时两组患者对镇痛和髋关节功能的满意度比较差异均无统计学意义(P>0.05)。两组均未发生皮肤瘙痒、切口浅表感染和深部感染、皮肤坏死、下肢深静脉血栓形成及肺栓塞等并发症,两组恶心呕吐、尿潴留、切口脂肪液化、局部血肿、血糖水平大幅度波动等并发症发生率比较差异无统计学意义(P>0.05)。结论加入得宝松的新型“鸡尾酒”LIA可有效减轻THA术后早期疼痛,减少术后阿片类药物用量,缩短住院时间,有利于患者术后早期功能康复。

Objective To study the analgesic effect of a new“cocktail”of local infiltration analgesia(LIA)with Deprosone after total hip arthroplasty(THA).Methods In a prospective randomized controlled study,100 patients with hip joint disease requiring unilateral primary THA in West China Hospital of Sichuan University between January2018 and December 2018 were enrolled and randomly divided into observation group and control group,with 50 cases in each group.There was no significant difference in age,gender,operative side,disease type,body mass index,American Society of Anesthesiologists(ASA)classification,preoperative rest and activity visual analogue scale(VAS)score,hip Harris score(HHS),quality of life scale(SF-12)score,and other general data between the two groups(P>0.05).The patients in the observation group were treated with a new“cocktail”LIA around the hip joint before suturing the incision,and the drug formula was ropivacaine 200 mg,Diprospan 1 mL,morphine 10 mg,and added normal saline to 80 mL;the patients in the control group were not treated with LIA.The operation time,postoperative hospital stay,the amount of morphine used during hospitalization,and the range of motion of hip joint at discharge were recorded,and the complications were counted.The VAS score at rest and activity,HHS score,and SF-12 score[physiological score(PCS)and psychological score(MCS)]of the hip joint were recorded before and after operation,and the postoperative analgesic effect and the recovery of hip joint function were evaluated.Results There was no significant difference in the operation time between the two groups(P>0.05),and the postoperative hospital stay in the observation group was significantly shorter than that in the control group(P<0.05).The postoperative morphine consumption in the observation group was significantly less than that in the control group(P<0.05),and the total morphine consumption in the observation group was less than that in the control group during hospitalization,but the difference was not significant(P>0.05).Patients in both groups were followed up to 6 months after operation.The resting VAS scores of the observation group were significantly lower than those of the control group at 2,6,12 hours after operation and in the morning and afternoon of the first day after operation,and the active VAS scores of the observation group were significantly lower than those of the control group at 6,12 hours after operation and in the morning of the first day after operation,and the differences were significant(P<0.05).There was no significant difference in the resting and active VAS scores between the two groups on the day of discharge and at 3 and 6 months after operation(P>0.05).At discharge,the flexion range of motion of hip joint in the observation group was significantly greater than that in the control group(P<0.05),but there was no significant difference in the abduction range of motion of hip joint between the two groups(P>0.05).There was no significant difference in HHS score and SF-12 score between the two groups at 3 and 6 months after operation(P>0.05).There was no significant difference in analgesic satisfaction and functional satisfaction between the two groups at last follow-up(P>0.05).There was no complication such as skin pruritus,superficial and deep infection of incision,skin necrosis,deep venous thrombosis of lower extremity,and pulmonary embolism in both groups.There was no significant difference in the incidence of complications such as nausea and vomiting,urine retention,fat liquefaction of incision,local hematoma,and large fluctuation of blood sugar between the two groups(P>0.05).Conclusion The new“cocktail”LIA with Diprospan can effectively reduce the early postoperative pain of THA,reduce the dosage of opioids,shorten the length of hospital stay,and is conducive to the early functional rehabilitation of patients.