利多卡因对全膝关节置换术患者疼痛及关节功能的作用

Effect of lidocaine combined with dezocine on pain and joint function in patients undergoing total knee arthroplasty

目的:探讨利多卡因联合地佐辛在全膝关节置换术(TKA)中对患者的镇痛效果以及对关节功能的作用。方法:采选取2021年4月至2023年8月行TKA的患者90例,采用随机数表法将其为2组,观察组利多卡因+地佐辛+舒芬太尼+昂丹司琼静脉自控镇痛,对照组地佐辛+舒芬太尼+昂丹司琼静脉自控镇痛,观察患者围术期指标、疼痛感受、膝关节活动度情况以及安全性指标。结果:观察组患者术后24 h和48 h时舒芬太尼用量[分别是(75.39±7.36)mL、(127.94±13.12)mL]均少于对照组[分别是(84.21±6.98)mL、(146.45±14.77)mL],且其自控镇痛按压次数和有效按压次数[分别是(18.26±3.74)次、(12.96±2.98)次]少于对照组[分别是(22.95±4.09)次、(16.49±3.87)次],差异具有统计学意义(P<0.05)。术后24 h和48 h时观察组膝关节活动度[分别是(82.91±7.09)°、(85.16±7.74)°]均高于对照前[分别是(77.39±6.97)°、(79.34±6.36)°],差异具有统计学意义(P<0.05)。不同镇痛方法和时间对患者的视觉模拟评分(VAS)的影响存在交互作用(P<0.05),在静息状态和运动状态下,观察组患者术后12 h(T1)、24 h(T2)时VAS评分[分别是(2.36±0.46)分、(2.96±0.63)分]低于对照组[分别是(2.53±0.64)分、(3.16±0.76)分],差异均有统计学意义(P<0.05)。结论:利多卡因联合地佐辛用于+舒芬太尼TKA手术后镇痛,可减少患者舒芬太尼用量和自控镇痛次数,减轻术后疼痛感受,且改善关节活动度,减轻不良反应发生率。

Objective:To investigate the effect of lidocaine combined with dezocine on pain degree and joint function in patients undergoing total knee arthroplasty(TKA).Methods:Ninety patients underoing TKA in our hospital from April 2021 to August 2023 were selected and assigned into two groups using random number tablemethod,with 45 cases in each.The patients in the observation group received lidocaine+dezocine+sufentanil+ondansetronfor analgesia,and those in the control group dezocine+sufentanil+ondansetronfor analgesia.Then the perioperative indexes,visual analogue scale(VAS),and range of motion as well as the safety profiles were compared between the two groups.Results:The dosage of sufentanil at 24h and 48h after operation in the observation group((75.39±7.36)mL,(127.94±13.12)mL)was less than that in the control group((84.21±6.98)mL,(146.45±14.77)mL),and the number of press and effective press of patient-controlled analgesia in the observation group((18.26±3.74)(12.96±2.98)times)was less than that in the control group((22.95±4.09)(16.49±3.87)times),the difference was statistically significant(P<0.05).At 24h and 48h after operation,the knee joint activity in the observation group((82.91±7.09)°and(85.16±7.74)°respectively)was higher than that in the control((77.39±6.97)°and(79.34±6.36)°respectively),and the difference was statistically significant(P<0.05).The effects of different analgesia methods and time on the visual analogue scale(VAS)of patients were interactive P<0.05).In the resting state and exercise state,the VAS scores at 12 h(T1)and 24 h(T2)in the observation group were(2.36±0.46)and(2.96±0.63)respectively,which were lower than those in the control group((2.53±0.64)and(3.16±0.76)respectively),and the differences were statistically significant(P<0.05).Conclusion:Application of lidocaine combined with dezocine in patients undergoing TKA can effectively reduce the amount of sufentanil and the number of compressions of the analgesic pump,alleviate postoperative pain,and improve joint range of motion and decrease the incidence of adverse effects.