Baker Joseph F, McGuire Ciara M, Byrne Damien P, Hunter Kim, Eustace Nick, Mulhall Kevin J
Department of Orthopaedic Surgery, Sports Surgery Clinic, Dublin - Ireland.
Hip Int. 2011 May-Jun;21(3):373-7. doi: 10.5301/HIP.2011.8390. Epub 2011 Jun 7.
The optimum anaesthetic and analgesic management following hip arthroscopy is yet to be determined. There is, in addition, some concern over the use of intraarticular local anaesthetic. We compared the analgesic efficacy of intra-articular infiltration compared with portal infiltration of bupivacaine following hip arthroscopy. Patients were randomised to receive either 10 ml of 0.25% bupivacaine either into the joint or around the portal sites following completion of surgery. 73 patients were recruited (40 intra-articular). The portal infiltration group required significantly more rescue analgesia immediately after surgery (2.33 mg vs.0.57 mg, p=0.036). Visual Analogue Scale pain scores were not significantly different at 1 and 2 hours following surgery, but at 6 hours the portal group had significantly lower VAS scores (p=0.0036). We believe that the initial pain following surgery results from capsular injury and this explains the need for more rescue analgesia in the portal infiltration group. Further work is needed to establish the ideal regimen. A combination of portal and intra-articular infiltration may be the most efficacious.
髋关节镜检查后的最佳麻醉和镇痛管理方案尚未确定。此外，对于关节腔内局部麻醉的使用也存在一些担忧。我们比较了髋关节镜检查后关节腔内注射与布比卡因门周围浸润的镇痛效果。患者被随机分为两组，一组在手术结束后于关节内注射10毫升0.25%布比卡因，另一组在门周围注射。共招募了73名患者（40名接受关节内注射）。门周围浸润组在术后立即需要显著更多的补救性镇痛（2.33毫克对0.57毫克，p = 0.036）。术后1小时和2小时视觉模拟量表疼痛评分无显著差异，但在6小时时，门周围注射组的VAS评分显著更低（p = 0.0036）。我们认为术后初期疼痛是由关节囊损伤引起的，这解释了门周围浸润组需要更多补救性镇痛的原因。需要进一步的研究来确定理想的方案。门周围和关节腔内浸润相结合可能是最有效的。
