El-Husseini T, El-Kawy S, Shalaby H, El-Sebai M
Arthroplasty Unit, Ain Shams University, Cairo, Egypt.
Int Orthop. 2007 Apr;31(2):229-33. doi: 10.1007/s00264-006-0149-0. Epub 2006 Aug 2.
Pain control following painful orthopaedic procedures such as total knee arthroplasty (TKA) is an ongoing challenge, as current pain management techniques often result in under-medication and/or complications. In a study designed to test the effect of the micro-current skin patch (MCT) on pain relief in patients following TKA, we followed 24 patients, randomly divided into two groups, one group receiving MCT plus tramadol hydrochloride (tramadol) for pain relief and a control group receiving only tramadol, for 10 days postoperatively. Tramadol was given intramuscularly in increment doses of 100 mg, as needed, for the duration of the study period. Pain was assessed daily using a visual analogue score (VAS). Other parameters, including the effect of MCT on the dose of tramadol needed for pain relief, the degree of wound healing measured at the end of the follow-up period, category of the wound 10 days postoperatively (1, 2 or 3) and total drain fluid volume, were also assessed. During the 10-day postoperative period there was a progressive decrease in pain in patients of both groups, however the patients of the MCT group showed a consistently lower VAS throughout the observation period, most markedly on those follow-up days with the highest pain scores in patients of the control group. This effect was monitored on the basis of the average dose of tramadol administered per day: 200.0+/-7.0 mg/day in the control group and 63.3+/-15.8 mg/day in the MCT group. Wound healing was better with the application of the MCT patch: grade 1 wounds were observed in 50% of the patients of the MCT group as compared to 8.3% in control group. The total drain volume was lower in patients of the MCT group compared to the controls (1020.8+/-211.6 and 1170.8+/-243.5 ml, respectively). None of the patients indicated that they wished to discontinue MCT therapy. This pilot study shows that MCT therapy led to better pain control with a markedly lower need for tramadol as compared to the control group. This better pain control was accompanied by a better healing of the wound and a lower drain volume.
诸如全膝关节置换术(TKA)等骨科疼痛手术后的疼痛控制一直是一项挑战,因为当前的疼痛管理技术常常导致用药不足和/或并发症。在一项旨在测试微电流皮肤贴片(MCT)对TKA术后患者疼痛缓解效果的研究中,我们对24名患者进行了跟踪,将他们随机分为两组,一组接受MCT加盐酸曲马多用于止痛,另一对照组仅接受曲马多,术后持续10天。在研究期间,根据需要,曲马多以100毫克的递增剂量进行肌肉注射。每天使用视觉模拟评分(VAS)评估疼痛。还评估了其他参数,包括MCT对止痛所需曲马多剂量的影响、随访期结束时测量的伤口愈合程度、术后10天的伤口类别(1、2或3)以及总引流量。在术后10天期间,两组患者的疼痛均逐渐减轻,然而,MCT组患者在整个观察期内的VAS评分始终较低,在对照组患者疼痛评分最高的那些随访日最为明显。这种效果是根据每天给予的曲马多平均剂量来监测的:对照组为200.0±7.0毫克/天,MCT组为63.3±15.8毫克/天。使用MCT贴片时伤口愈合更好:MCT组50%的患者观察到为1级伤口,而对照组为8.3%。与对照组相比,MCT组患者的总引流量更低(分别为1020.8±211.6毫升和1170.8±243.5毫升)。没有患者表示希望停止MCT治疗。这项初步研究表明,与对照组相比,MCT治疗能更好地控制疼痛,对曲马多的需求明显更低。这种更好的疼痛控制伴随着更好的伤口愈合和更低的引流量。