Rasmussen Sten, Kramhøft Morten U, Sperling Kim P, Pedersen Jens H L
Department of Orthopedic Surgery, Hamlet Private Hospital, Copenhagen, Denmark.
Acta Orthop Scand. 2004 Oct;75(5):606-9. doi: 10.1080/00016470410001501.
A single injection of bupivacaine after wound closure reduces the need for analgesics and increases flexion after total knee replacement (TKR). We have therefore studied the effect of continuous injection of morphine and ropivacaine after TKR on range of movement and length of hospital stay.
In an open intervention study, we assigned 154 consecutive patients who had primary unilateral TKR for osteoarthrosis. The intervention was continuous intraarticular injection of morphine 20 mg/mL, 0.5 mL plus ropivacaine 2 mg/mL, 100 mL; bolus 20 mL and 2 mL/hour from 24 to 72 hours postoperatively. Group 1 (10 women and 8 men) received standard postoperative analgesics and group 2 (11 women and 7 men) also received continuous intraarticular morphine and ropivacaine as described above. Group 3 (14 women and 4 men) received double this dose (4 mL/hour) from 24 to 72 hours postoperatively. To assess the safety of the intraarticular treatment, an additional group of 100 consecutive patients was followed (group 4).
At discharge, flexion was 70 degrees (60-100) in group 1, 100 degrees (70-115) in group 2 and 110 degrees (90-130) in group 3. Hospital stay was reduced from 9 (7-11) days in group 1, to 7 (5-10) days in groups 2 and 3. Number of days elapsed until the patient was walking with crutches was reduced from 5 (3-8) to 4 (3-6) and 3 (3-9), respectively. In the intervention groups, the need for analgesics was reduced during the hospital stay. Deep infection was registered in 1 patient.
Continuous intraarticular morphine and ropivacaine reduce pain and enhance rehabilitation after total knee replacement. Before advocating this as a standard procedure, further large-scale randomized studies will be needed to assess the safety of this regimen.
伤口闭合后单次注射布比卡因可减少全膝关节置换术（TKR）后对镇痛药的需求，并增加膝关节的屈曲度。因此，我们研究了TKR后持续注射吗啡和罗哌卡因对关节活动范围和住院时间的影响。
在一项开放性干预研究中，我们纳入了154例因骨关节炎接受初次单侧TKR的连续患者。干预措施为持续关节内注射20mg/mL的吗啡0.5mL加2mg/mL的罗哌卡因100mL；术后24至72小时推注20mL，然后以2mL/小时的速度持续注射。第1组（10名女性和8名男性）接受标准术后镇痛药，第2组（11名女性和7名男性）也接受上述持续关节内吗啡和罗哌卡因注射。第3组（14名女性和4名男性）在术后24至72小时接受双倍剂量（4mL/小时）的注射。为评估关节内治疗的安全性，另外纳入了100例连续患者作为第4组进行随访。
出院时，第1组的膝关节屈曲度为70度（60 - 100度），第2组为100度（70 - 115度），第3组为110度（90 - 130度）。住院时间从第1组的9天（7 - 11天）减少到第2组和第3组的7天（5 - 10天）。患者开始使用拐杖行走的天数分别从第1组的5天（3 - 8天）减少到第2组的4天（3 - 6天）和第3组的3天（3 - 9天）。在干预组中，住院期间对镇痛药的需求减少。有1例患者发生深部感染。
持续关节内注射吗啡和罗哌卡因可减轻全膝关节置换术后的疼痛并促进康复。在将此方法作为标准治疗方案推广之前，需要进一步进行大规模随机研究以评估该方案的安全性。
