Andersen Karen V, Pfeiffer-Jensen Mogens, Haraldsted Viggo, Søballe Kjeld
Department of Orthopedic Surgery, Aarhus University Hospital, Aarhus, Denmark.
Acta Orthop. 2007 Apr;78(2):180-6. doi: 10.1080/17453670710013654.
Epidural analgesia gives excellent pain relief but is associated with substantial side effects. We compared wound infiltration combined with intraarticular injection of local anesthetics for pain relief after total hip arthroplasty (THA) with the well-established practice of epidural infusion.
80 patients undergoing elective THA under spinal block were randomly assigned to receive either (1) continuous epidural infusion (group E) or (2) infiltration around the hip joint with a mixture of 100 mL ropivacaine 2 mg/mL, 1 mL ketorolac 30 mg/mL, and 1 mL epinephrine 0.5 mg/mL at the conclusion of surgery combined with one postoperative intraarticular injection of the same substances through an intraarticular catheter (group A).
Narcotic consumption was significantly reduced in group A compared to group E (p = 0.004). Pain levels at rest and during mobilization were similar in both groups but significantly reduced in group A after cessation of treatment. Length of stay was reduced by 2 days (36%) in group A compared to group E (p < 0.001).
Wound infiltration combined with 1 intraarticular injection can be recommended for patients undergoing THA. Further studies of dosage (high/low) and duration of intraarticular treatment are warranted.
硬膜外镇痛能有效缓解疼痛，但会产生大量副作用。我们将全髋关节置换术（THA）后伤口浸润联合关节内注射局部麻醉药用于缓解疼痛与成熟的硬膜外输注方法进行了比较。
80例在脊髓阻滞下接受择期THA的患者被随机分配接受以下两种方式之一：（1）持续硬膜外输注（E组）；（2）手术结束时用100 mL 2 mg/mL罗哌卡因、1 mL 30 mg/mL酮咯酸和1 mL 0.5 mg/mL肾上腺素的混合物在髋关节周围进行浸润，并通过关节内导管在术后进行一次相同物质的关节内注射（A组）。
与E组相比，A组的麻醉药物消耗量显著减少（p = 0.004）。两组静息和活动时的疼痛水平相似，但A组在治疗停止后疼痛水平显著降低。与E组相比，A组的住院时间缩短了2天（36%）（p < 0.001）。
对于接受THA的患者，可推荐伤口浸润联合1次关节内注射。有必要进一步研究关节内治疗的剂量（高/低）和持续时间。
