Joint Reconstruction Center, Department of Orthopaedic Surgery, Seoul National University Bundang Hospital, 166 Gumi-ro, Bundang-gu, Seongnam-si, Gyeonggi-do 463-707, Korea.
Knee Surg Sports Traumatol Arthrosc. 2010 Jul;18(7):916-22. doi: 10.1007/s00167-010-1051-2. Epub 2010 Jan 30.
The authors investigated the clinical value of intraoperative periarticular multimodal drug injections (PMDI) in patients on continuous epidural analgesia after simultaneous bilateral TKAs. In 55 patients scheduled to undergo simultaneous bilateral TKAs, one knee was randomly assigned to the PMDI group for which intraoperative periarticular injections were administered and the other knee was assigned to the No-PMDI group for which the injections were not done. These two groups were compared for pain level (during the operation night and on postoperative days (POD) 1, 4, and 7), functional recovery (ability to perform straight leg raising on POD 1 and maximum flexion on POD 7), patient satisfaction (POD 7), and the incidence of wound complications. The PMDI group showed a lower pain level during the operation night and on POD 1 than the No-PMDI group, but no differences in pain levels were observed between the groups on POD 4 or 7. Furthermore, no significant group differences were found in terms of functional recovery, patient satisfaction. No wound complication has been occurred in the PMDI group. This study demonstrates that PMDI provides additional pain relief limited to the immediate postoperative period but does not improve pain relief after POD 1, patient satisfaction and functional recovery.
作者研究了连续硬膜外镇痛下同期双侧全膝关节置换术（TKA）患者术中关节周围多模式药物注射（PMDI）的临床价值。55 例行同期双侧 TKA 的患者中，随机选择一侧膝关节（PMDI 组）行术中关节周围注射，另一侧膝关节（无 PMDI 组）不注射。比较两组患者的疼痛水平（手术当晚和术后第 1、4、7 天）、功能恢复（术后第 1 天直腿抬高能力和第 7 天最大屈曲度）、患者满意度（术后第 7 天）和伤口并发症发生率。PMDI 组患者手术当晚和术后第 1 天的疼痛水平低于无 PMDI 组，但第 4 天和第 7 天两组疼痛水平无差异。此外，两组患者在功能恢复和患者满意度方面也没有显著差异。PMDI 组无伤口并发症发生。本研究表明，PMDI 可提供即刻术后镇痛，但不能改善第 1 天以后的疼痛缓解、患者满意度和功能恢复。
