Bianconi M, Ferraro L, Traina G C, Zanoli G, Antonelli T, Guberti A, Ricci R, Massari L
Department of Anesthesiology and Intensive Care, St Anna Hospital Ferrara, Ferrara, Italy.
Br J Anaesth. 2003 Dec;91(6):830-5. doi: 10.1093/bja/aeg277.
As continuous wound instillation with local anaesthetic has not been evaluated after hip/knee arthroplasties, our study was designed to determine whether this technique could enhance analgesia and improve patient outcome after joint replacement surgery.
Thirty-seven patients undergoing elective hip/knee arthroplasties under spinal block were randomly assigned to two analgesia groups. Group M received continuous i.v. infusion of morphine plus ketorolac for 24 h. Then, a multi-hole 16 G catheter was placed subcutaneously and infusion of saline was maintained for 55 h. Group R received i.v. saline. Thereafter the wound was infiltrated with a solution of ropivacaine 0.5% 40 ml, then a multi-hole 16 G catheter was placed subcutaneously and an infusion of ropivacaine 0.2% 5 ml h(-1) was maintained for 55 h. Visual analogue scale scores were assessed at rest and on passive mobilization by nurses blinded to analgesic treatment. Total plasma ropivacaine concentration was measured.
Group R showed a significant reduction in postoperative pain at rest and on mobilization, while rescue medication requirements were greater in Group M. Total ropivacaine plasma concentration remained below toxic concentrations and no adverse effects occurred. Length of hospital stay was shorter in Group R.
Infiltration and wound instillation with ropivacaine 0.2% is more effective in controlling postoperative pain than systemic analgesia after major joint replacement surgery.
由于尚未对髋/膝关节置换术后持续伤口滴注局部麻醉药进行评估，我们开展本研究以确定该技术能否增强镇痛效果并改善关节置换手术后的患者预后。
37例在脊髓阻滞下接受择期髋/膝关节置换术的患者被随机分为两个镇痛组。M组接受吗啡加酮咯酸持续静脉输注24小时。然后，将一根16G多孔导管皮下置入，并维持55小时的生理盐水输注。R组接受静脉输注生理盐水。此后，用40ml 0.5%罗哌卡因溶液浸润伤口，然后皮下置入一根16G多孔导管，并以0.2%罗哌卡因5ml/h的速度维持输注55小时。由对镇痛治疗不知情的护士在患者静息和被动活动时评估视觉模拟量表评分。测量罗哌卡因的血浆总浓度。
R组在静息和活动时的术后疼痛显著减轻，而M组的急救药物需求量更大。罗哌卡因血浆总浓度保持在中毒浓度以下，未发生不良反应。R组的住院时间更短。
在大关节置换手术后，0.2%罗哌卡因浸润和伤口滴注在控制术后疼痛方面比全身镇痛更有效。
