Farag Ehab, Dilger John, Brooks Peter, Tetzlaff John E
Division of Anesthesiology and Critical Care Medicine, The Cleveland Clinic Foundation, Cleveland, OH 44195, USA.
J Clin Anesth. 2005 Jun;17(4):281-5. doi: 10.1016/j.jclinane.2004.08.008.
To compare epidural anesthesia and analgesia with spinal anesthesia with intravenous morphine analgesia for its effect on range of motion (ROM) and early rehabilitation after total knee replacement.
Randomized prospective study.
Tertiary care, academic medical center.
Thirty-eight patients scheduled for total knee replacement.
Patients were randomized into 2 groups. One group received spinal anesthesia with 0.5% bupivacaine and analgesia with intravenous patient-controlled analgesia morphine, demand mode only. The other group was given epidural anesthesia with 1.0% ropivacaine with 1:200,000 epinephrine and analgesia with 0.2% ropivacaine at 8 mL/h, maintained for 7 days. Both groups had compression stocking for deep venous thrombosis (DVT) prophylaxis, urinary catheter for the first 24 hours, and duplex scanning at days 3 and 10. The spinal group received low molecular-weight heparin for DVT prophylaxis.
Data collected included pain scores at rest, and with ROM, frequency of DVT, and patient satisfaction. Data were evaluated with Wilcoxon rank sum test for continuous variables and Fisher exact test for categorical variables. Data were considered significant at P < .05.
All 38 patients finished the study, 22 in the spinal group and 16 in the epidural group. There was no difference in demographics between groups. The pain sores at rest and with ROM were significantly less in the epidural group. ROM was better in the epidural group compared with the spinal group after day 1. No DVT was detected on day 3 or 10 in either group. No patient in either group required reinsertion of bladder catheter for urinary retention.
By using epidural analgesia in the first 7 days postoperatively, we achieved improved early rehabilitation due to excellent pain relief effect and an antithrombotic effect with an efficacy comparable to low molecular-weight heparin.
比较硬膜外麻醉与镇痛和腰麻联合静脉注射吗啡镇痛对全膝关节置换术后活动范围（ROM）及早期康复的影响。
随机前瞻性研究。
三级医疗学术医学中心。
38例计划行全膝关节置换术的患者。
患者被随机分为两组。一组接受0.5%布比卡因腰麻及仅按需模式的静脉自控镇痛吗啡镇痛。另一组给予含1:200,000肾上腺素的1.0%罗哌卡因硬膜外麻醉，并以8 mL/h的速度给予0.2%罗哌卡因镇痛，持续7天。两组均使用弹力袜预防深静脉血栓形成（DVT），术后前24小时留置导尿管，并在第3天和第10天进行双功超声扫描。腰麻组接受低分子量肝素预防DVT。
收集的数据包括静息及活动时的疼痛评分、DVT发生频率和患者满意度。连续变量的数据采用Wilcoxon秩和检验进行评估，分类变量的数据采用Fisher精确检验进行评估。P < 0.05时数据被认为具有统计学意义。
38例患者均完成研究，腰麻组22例，硬膜外组16例。两组患者的人口统计学特征无差异。硬膜外组静息及活动时的疼痛评分明显更低。术后第1天之后，硬膜外组的ROM比腰麻组更好。两组在第3天和第10天均未检测到DVT。两组均无患者因尿潴留需要重新插入膀胱导尿管。
通过在术后第1周使用硬膜外镇痛，我们实现了早期康复的改善，这归因于良好的镇痛效果和与低分子量肝素相当的抗血栓作用。
