Fu P L, Xiao J, Zhu Y L, Wu H S, Li X H, Wu Y L, Qian Q R
Department of Orthopaedics, Changzheng Hospital, Shanghai, China.
J Int Med Res. 2010 Jul-Aug;38(4):1404-12. doi: 10.1177/147323001003800422.
A total of 100 osteoarthritis patients undergoing unilateral total knee arthroplasty were randomly assigned to receive either a multimodal analgesia protocol, comprising oral celecoxib and tramadol before and after surgery and intra-articular injection of large doses of morphine, ropivacaine, adrenaline and betamethasone during surgery (trial group), or oral and intra-articular placebo (control group). All patients received patient-controlled analgesia for 48 h after surgery. Morphine consumption up to 48 h after surgery was significantly lower in the trial than in the control group. Compared with the control group, the trial group had significantly lower visual analogue scale (VAS) scores for pain at rest from 6 h to 7 days after surgery and significantly lower VAS scores during activity from 24 h to 7 days after surgery. Active straight leg raise and active 90 degrees knee flexion were achieved sooner and range of knee movement at postoperative days 1 - 15 were significantly greater in the trial group. Postoperative wound healing, infection, blood pressure, heart rate, rash, respiratory depression, urinary retention and deep vein thrombosis were similar in the two groups, but nausea and vomiting were significantly less frequent in the trial group.
总共100例接受单侧全膝关节置换术的骨关节炎患者被随机分配，分别接受多模式镇痛方案（试验组）或口服及关节内安慰剂（对照组）。多模式镇痛方案包括术前和术后口服塞来昔布和曲马多，以及术中关节内注射大剂量吗啡、罗哌卡因、肾上腺素和倍他米松。所有患者术后均接受48小时的患者自控镇痛。术后48小时内试验组的吗啡消耗量显著低于对照组。与对照组相比，试验组术后6小时至7天静息时的视觉模拟评分（VAS）疼痛评分显著更低，术后24小时至7天活动时的VAS疼痛评分也显著更低。试验组更快实现主动直腿抬高和主动屈膝90度，术后1 - 15天膝关节活动范围也显著更大。两组术后伤口愈合、感染、血压、心率、皮疹、呼吸抑制、尿潴留和深静脉血栓形成情况相似，但试验组恶心和呕吐的发生率显著更低。
