Fagan Daniel J, Martin William, Smith Alison
Department of Trauma and Orthopaedic Surgery, Weston General Hospital, Weston-Super-Mare, North Somerset, England.
Arthroscopy. 2003 Jan;19(1):50-3. doi: 10.1053/jars.2003.50002.
The study goal was to assess the efficacy of pre-emptive analgesia in a clinical setting.
A block randomized, double-blind design was used.
Subjects were 40 patients undergoing day-case arthroscopy of the knee. The trial group received a prophylactic injection of bupivacaine with adrenaline. After surgery, a placebo injection was given. The postsurgical injection group received identical injections in reverse order. There was no difference in the mean dose of propofol used to maintain general anesthesia between groups: 15 mg/kg/h (standard deviation [SD] = 2.85) trial versus 14.6 mg/kg/h (SD = 1.96) postsurgical injection (95% confidence interval [CI] = -1.14 to 1.94).
Although no statistically significant difference was observed in postoperative pain scores at 15, 30, or 60 minutes, there was a trend for the trial group to require less analgesia in recovery (chi2 = 9.74; P =.1).
Prophylactic local anesthesia confers no statistically significant reduction in pain scores or perioperative general anesthetic requirements as compared with postoperative administration. The pre-emptive effect in clinical practice may be less dramatic than that observed in more controlled animal models. Further studies are required to investigate the magnitude of the pre-emptive effect in clinical practice.
本研究的目标是评估临床环境中预先镇痛的疗效。
采用区组随机、双盲设计。
研究对象为40例行日间膝关节镜检查的患者。试验组接受布比卡因加肾上腺素的预防性注射。术后给予安慰剂注射。术后注射组按相反顺序接受相同的注射。两组间用于维持全身麻醉的丙泊酚平均剂量无差异：试验组为15mg/kg/h（标准差[SD]=2.85），术后注射组为14.6mg/kg/h（SD=1.96）（95%置信区间[CI]=-1.14至1.94）。
虽然在术后15、30或60分钟时观察到术后疼痛评分无统计学显著差异，但试验组在恢复过程中需要的镇痛药物有减少的趋势（χ2=9.74；P=0.1）。
与术后给药相比，预防性局部麻醉在疼痛评分或围手术期全身麻醉需求方面无统计学显著降低。临床实践中的预先镇痛效果可能不如在更具控制性的动物模型中观察到的那样显著。需要进一步研究以探讨临床实践中预先镇痛效果的程度。
