Talu Gül K, Ozyalçin Süleyman, Koltka Kemallettin, Ertürk Engin, Akinci Ozkan, Aşik Mehmet, Pembeci Kamil
Department of Pain Management, Medical Faculty of Istanbul University, Monoblok, Capa Klinikleri, 34390 Istanbul, Turkey.
Knee Surg Sports Traumatol Arthrosc. 2002 Nov;10(6):355-60. doi: 10.1007/s00167-002-0306-y. Epub 2002 Aug 7.
Arthroscopic knee surgery is one of the most common surgeries done in outpatient settings; however, postoperative pain is believed to be the major barrier for discharge and early rehabilitation. In this study we evaluated and compared the efficacy of intraarticular application of long-lasting non-steroidal analgesic drug tenoxicam, a long-lasting local anaesthetic bupivacaine and combination of the two on postoperative pain after arthroscopic knee surgery. With the approval of the local ethics committee and signed informed consent of the patients, 75 American Society of Anesthesiologists I-II patients aged between 18 and 65 years going under elective arthroscopic meniscectomy were included in this randomized, blind, prospective study. The patients were divided into three groups: group-T (GT) patients ( n=25) had intraarticular 20 mg of tenoxicam in 20 ml normal saline; group-B (GB) patients ( n=25) had 50 mg bupivacaine in 20 ml normal saline (0.25%); group-BT (GBT) patients ( n=25) had intraarticular 20 mg of tenoxicam and 50 mg bupivacaine (0.25%) in 20 ml normal saline after completion of the surgery and before deflation of the tourniquet. Postoperative analgesia was maintained by intravenous tramadol hydrochloride 50 mg/s at the first 4 h and paracetamol 500 mg and codeine 7.5 mg preparation (Pacofen) as needed (maximum six per day) during the study period. The numeric rating scale (NRS) values were at rest and at active-passive motion at 4, 12, 24 and 48 h, total analgesic consumption, at 4 h for tramadol and at the end of 48 h for oral medication; and patient satisfaction at the end of 48 h was evaluated and recorded. The demographic features of the patients, and tourniquet times, were found to be similar between the groups. Group BT had significantly lower NRS values than GB at 12 h at rest. Group BT was found to have significantly lower NRS values at 4 h compared with GT, and significantly lower NRS values at 12 h compared with GB. Group BT was found to have significantly lower NRS values at 48 h compared with GB. Group T had significantly higher NRS values at 4 h compared with GB. Group B had significantly higher values at 12 h compared with GT and GBT. Group B used significantly more analgesics than GBT and GT throughout the study period. Group BT patients had significantly more satisfaction at the end of the study period when compared with GT and GB. Application of intraarticular tenoxicam-bupivacaine solution is a simple, safe and effective method of analgesia after arthroscopic meniscectomy with high patient satisfaction.
关节镜膝关节手术是门诊最常见的手术之一；然而，术后疼痛被认为是出院和早期康复的主要障碍。在本研究中，我们评估并比较了长效非甾体类镇痛药替诺昔康、长效局麻药布比卡因以及两者联合应用于关节镜膝关节手术后对术后疼痛的疗效。经当地伦理委员会批准并获得患者签署的知情同意书后，本随机、盲法、前瞻性研究纳入了75例年龄在18至65岁之间、拟行择期关节镜半月板切除术的美国麻醉医师协会I-II级患者。患者被分为三组：替诺昔康组（GT组，n = 25）患者在20 ml生理盐水中注入20 mg替诺昔康；布比卡因组（GB组，n = 25）患者在20 ml生理盐水中注入50 mg布比卡因（0.25%）；布比卡因 - 替诺昔康组（GBT组，n = 25）患者在手术完成后、止血带放气前，于20 ml生理盐水中注入20 mg替诺昔康和50 mg布比卡因（0.25%）。术后镇痛在最初4小时通过静脉注射盐酸曲马多50 mg/秒维持，在研究期间根据需要使用对乙酰氨基酚500 mg和可待因7.5 mg制剂（帕考芬，每天最多6次）。记录患者在4、12、24和48小时静息及主动 - 被动活动时的数字评分量表（NRS）值、总镇痛药物消耗量（4小时时的曲马多用量以及48小时结束时的口服药物用量），并评估和记录48小时结束时患者的满意度。发现各组患者的人口统计学特征和止血带使用时间相似。GBT组在静息12小时时的NRS值显著低于GB组。GBT组在4小时时的NRS值显著低于GT组，在12小时时的NRS值显著低于GB组。GBT组在48小时时的NRS值显著低于GB组。T组在4小时时的NRS值显著高于GB组。B组在12小时时的值显著高于GT组和GBT组。在整个研究期间，B组使用的镇痛药显著多于GBT组和GT组。与GT组和GB组相比，GBT组患者在研究结束时的满意度显著更高。关节腔内应用替诺昔康 - 布比卡因溶液是关节镜半月板切除术后一种简单、安全且有效的镇痛方法，患者满意度高。
