Becchi C, Al Malyan M, Coppini R, Campolo M, Magherini M, Boncinelli S
Florence University, Department of Medical and Surgical Critical Care, Section of Anaesthesia and Intensive Care, Florence, Italy.
Eur J Anaesthesiol. 2008 May;25(5):418-23. doi: 10.1017/S026502150700302X. Epub 2007 Nov 21.
Adequate analgesia is needed after total hip arthroplasty to control pain at rest and during rehabilitation. Our aim was to compare, in a randomized study, the efficacy of two analgesia regimens in control of postoperative pain after total hip arthroplasty: opioid-free continuous psoas compartment block vs. an opioid/non-steroidal anti-inflammatory drugs continuous intravenous infusion.
In all, 73 patients (ASA I-III), aged 61-82 yr, undergoing total hip arthroplasty were prospectively enrolled in a single-blind randomized trial. Patients were allocated either to the study group (Group A, n = 37) or to the control group (Group B, n = 36). Patients in Group A underwent preoperative placement of a catheter in the psoas compartment and, 30 min before the end of surgery, the catheter was primed with a loading dose of 0.75% ropivacaine (0.4 mL kg(-1)) followed by a continuous infusion of 10 mL h(-1) ropivacaine 0.2% for 48 h. Patients in Group B received, from 1 h before the end of surgery, a continuous intravenous infusion of 0.1% morphine and 0.12% ketorolac at 2 mL h(-1) for 48 h. Both groups received spinal anaesthesia for surgery. Pain scores at rest and after mobilization, amount of rescue analgesia, nausea/vomiting and haemodynamic parameters were recorded.
In Group A, median pain scores were very low during the whole study duration both at rest and during physiotherapy in comparison to Group B. Less rescue analgesia was needed and less nausea and vomiting was observed in Group A.
Opioid-free continuous psoas compartment block seems to be an appropriate and reliable technique in providing effective postoperative analgesia at rest and during physiotherapy after total hip arthroplasty when compared to intravenous morphine/ketorolac infusion.
全髋关节置换术后需要充分镇痛以控制静息及康复期间的疼痛。我们的目的是在一项随机研究中比较两种镇痛方案对全髋关节置换术后疼痛的控制效果：无阿片类药物的持续腰大肌间隙阻滞与阿片类药物/非甾体类抗炎药持续静脉输注。
总共73例年龄在61 - 82岁、接受全髋关节置换术的患者（ASA分级I - III级）被前瞻性纳入一项单盲随机试验。患者被分配至研究组（A组，n = 37）或对照组（B组，n = 36）。A组患者在术前将导管置入腰大肌间隙，手术结束前30分钟，导管先注入负荷剂量的0.75%罗哌卡因（0.4 mL/kg），随后以0.2%罗哌卡因10 mL/h持续输注48小时。B组患者从手术结束前1小时开始，以2 mL/h的速度持续静脉输注0.1%吗啡和0.12%酮咯酸48小时。两组患者均接受脊髓麻醉进行手术。记录静息及活动后的疼痛评分、补救性镇痛用量、恶心/呕吐情况及血流动力学参数。
与B组相比，A组在整个研究期间静息及理疗时的疼痛评分中位数都非常低。A组所需的补救性镇痛较少，恶心和呕吐也较少。
与静脉输注吗啡/酮咯酸相比，无阿片类药物的持续腰大肌间隙阻滞似乎是全髋关节置换术后在静息及理疗时提供有效术后镇痛的一种合适且可靠的技术。
