艾瑞昔布超前镇痛对患者前交叉韧带重建术后镇痛的疗效:一项随机对照研究

Effectiveness of preemptive analgesia with imrecoxib on analgesia after anterior cruciate ligament reconstruction:a randomized controlled study

目的探讨艾瑞昔布超前镇痛方案在前交叉韧带(anterior cruciate ligament,ACL)重建术后镇痛的效果。方法选取2020年11月—2021年8月收治且符合选择标准的ACL损伤患者160例,按照随机数字表法分为4组,每组40例。A组术前3 d开始服用艾瑞昔布(100 mg/次,2次/d);B组术前1 d开始服用艾瑞昔布(100 mg/次,2次/d);C组术前2 h服用200 mg艾瑞昔布,5 mL水顿服;D组术前不服用任何止痛药物。4组患者性别、年龄、身体质量指数、术前半月板损伤MRI分级≥3级构成比、软骨损伤Outerbridge分级≥3级构成比及术前受伤时和静息时疼痛视觉模拟评分(VAS)等基线资料比较,差异均无统计学意义(P>0.05)。记录手术时间、住院时间、围术期美国麻醉医师协会(ASA)分级1级构成比、术后阿片类药物使用量和并发症发生情况。采用VAS评分评价患者膝关节疼痛程度,包括术前及术后6、24、48 h和1、3、6、12个月静息VAS评分,术后1、3、6、12个月行走、屈膝、夜间VAS评分;膝关节损伤与骨关节炎评分(KOOS)评价患者术后生活质量及膝关节相关症状,主要包括疼痛、症状、日常活动、运动及娱乐功能、膝关节相关的生活质量(knee-related quality of life,QOL)5个方面;Lysholm评分评价膝关节功能。结果所有患者均完成1年随访,4组患者手术时间、住院时间、围术期ASA 1级构成比比较差异均无统计学意义(P>0.05);术后阿片类药物使用量A~C组明显少于D组(P<0.05)。除B组有1例术后出现发热外,各组均无关节感染、下肢深静脉血栓形成、膝关节不稳等并发症发生。A~C组术后6、24 h静息VAS评分均低于D组,A组术后6 h评分低于C组,差异均有统计学意义(P<0.05);术后1个月,A~C组屈膝VAS评分均低于D组,A、B组行走VAS评分均小于C、D组,差异均有统计学意义(P<0.05);术后1个月,A~C组KOOS疼痛评分均高于D组,A、B组与D组差异有统计学意义(P<0.05);A~C组KOOS QOL评分高于D组,差异均有统计学意义(P<0.05),A~C组间差异无统计学意义(P>0.05);其余各时间点各组间VAS和KOOS各项评分比较差异均无统计学意义(P>0.05)。术后1、3、6、12个月各组Lysholm功能评分比较差异均无统计学意义(P>0.05)。结论与传统镇痛方案比较,ACL重建围术期应用艾瑞昔布超前镇痛理念管理,能够有效减轻患者术后早期疼痛,减少阿片类药物使用量,促进患者肢体功能尽早恢复。

Objective To investigate the effectiveness of preemptive analgesia with imrecoxib on analgesia after anterior cruciate ligament(ACL)reconstruction.Methods A total of 160 patients with ACL injuries who met the selection criteria and were admitted between November 2020 and August 2021 were selected and divided into 4 groups according to the random number table method(n=40).Group A began to take imrecoxib 3 days before operation(100 mg/time,2 times/day);group B began to take imrecoxib 1 day before operation(100 mg/time,2 times/day);group C took 200 mg of imrecoxib 2 hours before operation(5 mL of water);and group D did not take any analgesic drugs before operation.There was no significant difference in gender,age,body mass index,constituent ratio of meniscal injuries with preoperative MRI grade 3,constituent ratio of cartilage injury Outerbridge grade 3,and visual analogue scale(VAS)score at the time of injury and at rest among 4 groups(P>0.05).The operation time,hospitalization stay,constituent ratio of perioperative American Society of Anesthesiologists(ASA)grade 1,postoperative opioid dosage,and complications were recorded.The VAS scores were used to evaluate the degree of knee joint pain,including resting VAS scores before operation and at 6,24,48 hours,and 1,3,6,and 12 months after operation,and walking,knee flexion,and night VAS scores at 1,3,6,and 12 months after operation.The knee injury and osteoarthritis score(KOOS)was used to evaluate postoperative quality of life and knee-related symptoms of patients,mainly including pain,symptoms,daily activities,sports and entertainment functions,knee-related quality of life(QOL);and the Lysholm score was used to evaluate knee joint function.Results All patients were followed up 1 year.There was no significant difference in operation time,hospitalization time,or constituent ratio of perioperative ASA grade 1 among 4 groups(P>0.05);the dosage of opioids in groups A-C was significantly less than that in group D(P<0.05).Except for 1 case of postoperative fever in group B,no complications such as joint infection,deep vein thrombosis of the lower extremities,or knee joint instability occurred in each group.The resting VAS scores of groups A-C at 6 and 24 hours after operation were lower than those of group D,and the score of group A at 6 hours after operation was lower than those of group C,and the differences were significant(P<0.05).At 1 month after operation,the knee flexion VAS scores of groups A-C were lower than those of group D,the walking VAS scores of groups A and B were lower than those of groups C and D,the differences were significant(P<0.05).At 1 month after operation,the KOOS pain scores in groups A-C were higher than those in group D,there was significant difference between groups A,B and group D(P<0.05);the KOOS QOL scores in groups A-C were higher than that in group D,all showing significant differences(P<0.05),but there was no significant difference between groups A-C(P>0.05).There was no significant difference in VAS scores and KOOS scores between the groups at other time points(P>0.05).And there was no significant difference in Lysholm scores between the groups at 1,3,6,and 12 months after operation(P>0.05).Conclusion Compared with the traditional analgesic scheme,applying the concept of preemptive analgesia with imrecoxib to manage the perioperative pain of ACL reconstruction can effectively reduce the early postoperative pain,reduce the dosage of opioids,and promote the early recovery of limb function.