Thorsell Martin, Holst Petter, Hyldahl Hans Christian, Weidenhielm Lars
Department of Orthopedics, Capio S:t Görans Hospital, Stockholm, Sweden.
Orthopedics. 2010 Feb;33(2):75-80. doi: 10.3928/01477447-20100104-13.
Postoperative pain control after total knee arthroplasty (TKA) is a well-known clinical problem. Efforts to treat it with the use of local anesthesia have been made, but the results have been contradictive. In the late 1990s, an infiltrated solution of ropivacaine/ketorolac/adrenaline was shown to be effective for this purpose, and this technique has since spread over the world. The purpose of this study was to compare the local infiltration anesthesia technique with epidural anesthesia, which has been the most widely used technique in Sweden.Eighty-five patients received either local infiltration anesthesia or epidural anesthesia for postoperative pain relief. Postoperative morphine consumption, range of motion, walking ability, patient satisfaction, hospital stay, and time in the recovery room were measured. The groups were followed equally. The patients in the local infiltration anesthesia group were mobilized 24 hours earlier. On postoperative day one, 22 of 33 patients in the local infiltration anesthesia group could get in and out of bed without assistance. Only 1 of 31 patients in the epidural anesthesia group could manage this. On postoperative day two, 28 of 33 patients in the local infiltration anesthesia group could walk without assistance, compared to 5 of 31 in the epidural anesthesia group. Seventy-six percent of the local infiltration anesthesia patients were "very satisfied" with their postoperative pain control method, compared to 40% of the epidural anesthesia patients.The local infiltration anesthesia technique is better for postoperative pain relief in TKA than epidural anesthesia. It offers equal pain relief, faster mobilization, and more satisfied patients. No negative side effects were seen during the study.
全膝关节置换术（TKA）后的术后疼痛控制是一个众所周知的临床问题。人们已努力使用局部麻醉来治疗该问题，但结果相互矛盾。在20世纪90年代后期，一种罗哌卡因/酮咯酸/肾上腺素的浸润溶液被证明在此方面有效，此后该技术已在全球传播。本研究的目的是将局部浸润麻醉技术与硬膜外麻醉进行比较，硬膜外麻醉在瑞典是使用最广泛的技术。
85名患者接受了局部浸润麻醉或硬膜外麻醉以缓解术后疼痛。测量了术后吗啡消耗量、关节活动范围、行走能力、患者满意度、住院时间和在恢复室的时间。对两组进行了同等的随访。局部浸润麻醉组的患者提前24小时开始活动。术后第一天，局部浸润麻醉组的33名患者中有22名可以在无协助的情况下上下床。硬膜外麻醉组的31名患者中只有1名能做到这一点。术后第二天，局部浸润麻醉组的33名患者中有28名可以在无协助的情况下行走，而硬膜外麻醉组的31名患者中有5名能做到。局部浸润麻醉患者中有76%对其术后疼痛控制方法“非常满意”，而硬膜外麻醉患者中这一比例为40%。
对于TKA术后疼痛缓解，局部浸润麻醉技术比硬膜外麻醉更好。它能提供同等的疼痛缓解、更快的活动能力和更满意的患者。在研究过程中未观察到负面副作用。
