Tuncer B, Babacan C A, Arslan M
Department of Anesthesiology and Reanimation, Faculty of Medicine, Gazi University, Ankara, Turkey.
Acta Anaesthesiol Scand. 2005 Oct;49(9):1373-7. doi: 10.1111/j.1399-6576.2005.00784.x.
The purpose of this study was to determine whether intra-articular injection of bupivacaine prior to surgery provided better pain control after arthroscopic meniscectomy as compared with post-operative administration of bupivacaine.
Forty patients of American Society of Anesthesiologists (ASA) class I or II undergoing arthroscopic meniscectomy were assigned in a randomized, double-blinded manner into two groups: Group I received 20 ml of 2.5 mg/ml bupivacaine without epinephrine 30 min before skin incision and 20 ml of saline immediately after skin closure. Group II received identical injections in reverse order. All patients received total intravenous anesthesia. Post-operative pain scores were evaluated at 1, 2, 4, 6, 8, 12 and 24 h at rest and movement of the knee, using a 10-cm visual analog scale (VAS). The time to first analgesic use and 24-h analgesic consumption were recorded.
Pain scores were lower in Group I compared with Group II at 1, 2, 4 and 6 h at rest and on movement (P < 0.05). The time to first analgesic use was longer in Group I, but there was no statistically significant difference in 24-h analgesic consumption.
Intra-articular bupivacaine administered before surgery provided a statistically significant reduction in post-operative pain scores compared with post-operative bupivacaine administration.
本研究的目的是确定与术后给予布比卡因相比，术前关节腔内注射布比卡因在关节镜下半月板切除术后是否能提供更好的疼痛控制。
40例美国麻醉医师协会（ASA）分级为I或II级且接受关节镜下半月板切除术的患者，以随机、双盲方式分为两组：第一组在皮肤切开前30分钟接受20毫升2.5毫克/毫升不含肾上腺素的布比卡因，皮肤缝合后立即接受20毫升生理盐水。第二组按相反顺序接受相同注射。所有患者均接受全静脉麻醉。使用10厘米视觉模拟量表（VAS）在术后1、2、4、6、8、12和24小时评估膝关节休息和活动时的疼痛评分。记录首次使用镇痛药的时间和24小时镇痛药消耗量。
在休息和活动时，第一组在术后1、2、4和6小时的疼痛评分低于第二组（P<0.05）。第一组首次使用镇痛药的时间更长，但24小时镇痛药消耗量无统计学显著差异。
与术后给予布比卡因相比，术前给予关节腔内布比卡因在统计学上能显著降低术后疼痛评分。
