局部应用氨甲环酸减少拇外翻矫正术后疼痛的疗效分析

Efficacy analysis of local application of tranexamic acid in reducing postoperative pain in hallux valgus surgery

目的评估拇外翻矫正术中截骨面局部应用氨甲环酸减少术后疼痛的早期疗效。方法选取2022年7—11月首都医科大学附属北京积水潭医院足踝外科收治的拇外翻行矫正术患者资料。根据是否局部应用氨甲环酸,分为氨甲环酸组和对照组。当疼痛强度大于5分时给予阿片类药物。统计患者一般资料,手术时间,术中出血量,术后12、24、36 h视觉模拟评分法(VAS)疼痛评分,是否应用阿片类药物及不良反应等。结果共纳入患者23例,氨甲环酸组11例,对照组12例。氨甲环酸组和对照组在性别、年龄、BMI、内科疾病、过敏、腰麻、手术等待时间、住院时间比较差异均无统计学意义(P>0.05);在手术时间、出血量方面差异亦无统计学意义(P>0.05)。氨甲环酸组有6例患者应用了阿片类药物,对照组有11例患者应用了阿片类药物,两组比较差异有统计学意义(P<0.05),VAS疼痛评分方面,术后12 h氨甲环酸组平均分为(2.09±0.30)分,对照组为(3.17±2.37)分,氨甲环酸组较对照组低,但两组比较差异无统计学意义(P>005);术后24 h氨甲环酸组平均分为(1.73±0.47)分,对照组为(1.75±0.45)分;术后36 h氨甲环酸组平均分为(1.81±0.40)分,对照组为(1.75±0.45)分,术后24 h、36 h评分两组比较差异亦无统计学意义(均P>0.05)。两组患者均未发生不良反应。结论拇外翻矫正术中局部应用氨甲环酸能减少阿片类药物用量,可能减轻术后疼痛。

Objective To evaluate the early efficacy of the local application of tranexamic acid on the osteotomy surface in reducing postoperative pain during bunion valgus surgery.Methods The data of patients who underwent hallux valgus sur⁃gery in the foot and ankle Surgery Department of Beijing Jishuitan Hospital,Capital Medical University from July to November 2022 were analyzed.Patients were divided into the tranexamic acid group and the control group based on whether tranexamic acid was applied locally.Opioids were administered when the pain intensity was greater than 5 points.Patients'general infor⁃mation,operation time,blood loss,visual analogue scale(VAS)pain score at 12,24,36 h after surgery,the use of opioids,and adverse reactions were recorded.Results A total of 23 patients were included,with 11 in the tranexamic acid group and 12 in the control group.There were no significant differences in gender,age,BMI,medical disease,allergy,lumbar anesthe⁃sia,operation waiting time,and hospital stay between the tranexamic acid group and the control group(P>0.05).There was no significant difference in operation time and blood loss(all P>0.05).A total of 6 patients in the tranexamic acid group re⁃ceived opioids,while 11 patients in the control group received opioids,showing a statistically significant difference between the two groups(P<0.05).In terms of VAS pain scores,the average score at 12 h after surgery was(2.09±0.30)points in the tranexamic acid group and(3.17±2.37)points in the control group,indicating a lower score in the tranexamic acid group,but the difference was not statistically significant(P>0.05).The VAS pain score at 24 h after operation was(1.73±0.47)points in the tranexamic acid group and(1.75±0.45)points in the control group.The VAS pain score at 36 h after surgery was(1.81±0.40)points in the tranexamic acid group and(1.75±0.45)points in the control group.There was no significant differ⁃ence between the two groups at 24 h and 36 h after surgery(P>0.05).No adverse reactions occurred in both groups.Conclusion Local application of tranexamic acid during hallux valgus surgery may reduce postoperative pain and save the amount of opioids.