Bech Rune D, Lauritsen Jens, Ovesen Ole, Emmeluth Claus, Lindholm Peter, Overgaard Søren
Department of Orthopaedics and Traumatology Odense University Hospital and University of Southern Denmark - Denmark.
Hip Int. 2011 Mar-Apr;21(2):251-9. doi: 10.5301/HIP.2011.6513. Epub 2011 Apr 5.
Pain control may assist early mobilisation after internal fixation of femoral neck fractures. Systemic opioids have significant side effects in elderly patients. We present an evaluation of the effect of local anaesthetic infiltration in such cases , the objective being to decrease the need for postoperative opioids and to improve pain control for patients after surgery. 33 patients undergoing internal fixation with 2 parallel hook pins were randomized into 2 groups in a double blind study (ClinicalTrials.gov: NCT00529425). 33 patients received intraoperative infiltration followed by 6 postoperative injections through an intraarticular catheter in eight-hour intervals. 19 patients received ropivacaine and 14 received saline. The intervention period was 48 hours and the observation period was 5 days. In both groups there were no restrictions on the total daily dose of rescue analgesics. Pain was assessed at specific postoperative time-points and the daily consumption of opioid drugs needed for analgesia was registered. There was no significantly reduced consumption of standardized opioid rescue analgesics or pain in the study group receiving ropivacaine injections. Apart from a reduction in nausea in the study group on the second postoperative day, there were no significant differences in the occurrence of side effects between the groups. On day 2 the placebo group had less pain than the study group. Local anaesthetic infiltration after fixation of femoral neck fractures does not reduce opioid consumption or pain'.
疼痛控制可能有助于股骨颈骨折内固定术后的早期活动。全身性阿片类药物对老年患者有显著的副作用。我们在此评估局部麻醉药浸润在此类病例中的效果，目的是减少术后阿片类药物的使用需求，并改善患者术后的疼痛控制。在一项双盲研究（ClinicalTrials.gov：NCT00529425）中，33例接受双平行钩针内固定术的患者被随机分为两组。33例患者术中接受浸润麻醉，术后通过关节内导管每隔8小时注射一次，共注射6次。19例患者接受罗哌卡因，14例患者接受生理盐水。干预期为48小时，观察期为5天。两组对补救性镇痛药的每日总剂量均无限制。在特定的术后时间点评估疼痛，并记录镇痛所需阿片类药物的每日消耗量。接受罗哌卡因注射的研究组中，标准化阿片类补救性镇痛药的消耗量或疼痛程度均未显著降低。除了术后第二天研究组恶心症状有所减轻外，两组副作用的发生率没有显著差异。在第二天，安慰剂组的疼痛比研究组轻。股骨颈骨折固定术后局部麻醉药浸润并不能减少阿片类药物的消耗量或减轻疼痛。
