Raimer Constance, Priem Kristin, Wiese Andrea A, Birnbaum Juergen, Dirkmorfeld Larissa M, Mossner Andrea, Matziolis Georg, Perka Carsten, Volk Thomas
Universitätsklinik für Department of Anesthesiology and Intensive Care, Charité Campus Mitte, Charitéplatz 1, Berlin, DE-10117, Germany.
Acta Orthop. 2007 Apr;78(2):193-200. doi: 10.1080/17453670710013672.
For endoprosthetic knee surgery, intensive postoperative pain therapy is necessary. We therefore evaluated whether the combination of continuous psoas compartment and sciatic analgesia (PSC) is as effective as epidural analgesia (EPI) and whether it provides better analgesia than patient-controlled intravenous analgesia with piritramide (PCA).
We studied 63 patients who underwent total knee arthroplasty (TKA). The PSC group received a combination of continuous psoas and sciatic nerve block, the EPI group an epidural analgesia, and the PCA group an intravenous patient-controlled piritramide pump. Pain scores, satisfaction, flexion and side effects were recorded.
Pain scores (0-10) were higher in the PCA group (on movement, day 1/day 2: 7.0/6.5) than in the EPI group (5.0/5.0) and the PSC group (4.0/3.5). Postoperative opioid consumption over 48 h was higher in the PCA group (51 mg) than in the EPI group (0 mg) and the PSC group (0 mg). There were no differences in functional recovery. Pruritus occurred more frequently in the PCA and EPI groups than in the PSC group. Patients receiving a PSC and EPI were more satisfied than those treated with PCA.
Analgesia with PSC catheters or EPI catheter is superior to PCA regarding pain levels, analgesic requirements, and patient satisfaction. There was no difference in functional outcome between the 3 groups.
对于人工膝关节置换手术，术后强化疼痛治疗是必要的。因此，我们评估了持续腰大肌间隙和坐骨神经镇痛（PSC）联合使用是否与硬膜外镇痛（EPI）效果相同，以及它是否比使用匹利卡明的患者自控静脉镇痛（PCA）提供更好的镇痛效果。
我们研究了63例行全膝关节置换术（TKA）的患者。PSC组接受持续腰大肌间隙和坐骨神经阻滞联合治疗，EPI组接受硬膜外镇痛，PCA组使用静脉自控匹利卡明泵。记录疼痛评分、满意度、关节活动度和副作用。
PCA组的疼痛评分（0 - 10分）（术后第1天/第2天活动时：7.0/6.5）高于EPI组（5.0/5.0）和PSC组（4.0/3.5）。PCA组48小时内的术后阿片类药物消耗量（51毫克）高于EPI组（0毫克）和PSC组（0毫克）。功能恢复方面无差异。PCA组和EPI组瘙痒的发生率高于PSC组。接受PSC和EPI治疗的患者比接受PCA治疗的患者更满意。
在疼痛程度、镇痛需求和患者满意度方面，使用PSC导管或EPI导管进行镇痛优于PCA。三组之间的功能结局无差异。
