Department of Rheumasurgery, Spenshult Hospital, Oskarström, Sweden.
Acta Orthop. 2011 Dec;82(6):692-8. doi: 10.3109/17453674.2011.625535. Epub 2011 Oct 25.
Ropivacaine infusion following high-volume local infiltration analgesia has been shown to be effective after total knee arthroplasty, but the optimum site of administration of ropivacaine has not been evaluated. We compared the effects of intraarticular and extraarticular adminstration of the local anesthetic for postoperative supplementation of high-volume local infiltration analgesia.
In this double-blind study, 36 rheumatic patients aged 51-78 years with physical status ASA 2-3 who were scheduled for total knee arthroplasty were randomized into 2 groups. All patients received wound infiltration at the end of surgery with 300 mg ropivacaine, 30 mg ketorolac, and 0.5 mg epinephrine (total volume 156 mL). A tunneled catheter was randomly placed either extraarticularly or intraarticularly. Continuous infusion of ropivacain (0.5%, 2 mL/h) was started immediately and was maintained during the next 48 h. Pain intensity at rest, on movement, and with mobilization was estimated by the patients and the physiotherapist; rescue morphine consumption was recorded.
As estimated by the patients, ropivacaine administered intraarticularly did not improve analgesia relative to extraarticular infusion, but improved the first mobilization. The incidence of high intensity of pain (VAS 7-10) was less in the group with intraarticular infusion. Analgesic requirements were similar in the 2 groups (47 mg and 49 mg morphine). No complications of postoperative wound healing were seen and there were no toxic side effects.
Continuous infusion of ropivacaine intraarticulary did not improve postoperative analgesia at rest relative to extraarticular administration, but it appeared to reduce the incidence of high pain intensity during first exercises, and could therefore be expected to improve mobilization up to 24 h after total knee arthroplasty.
大量局部浸润镇痛后输注罗哌卡因已被证明对全膝关节置换术后有效，但尚未评估罗哌卡因的最佳给药部位。我们比较了关节内和关节外给予局部麻醉药对大量局部浸润镇痛术后补充的效果。
在这项双盲研究中，36 名年龄在 51-78 岁之间、身体状况 ASA 2-3 的风湿性关节炎患者，计划接受全膝关节置换术，随机分为 2 组。所有患者在手术结束时接受 300mg 罗哌卡因、30mg 酮咯酸和 0.5mg 肾上腺素（总容量 156ml）的伤口浸润。将带隧道的导管随机置于关节外或关节内。罗哌卡因（0.5%，2ml/h）持续输注立即开始，并在接下来的 48 小时内维持。患者和物理治疗师估计静息、运动和活动时的疼痛强度；记录解救性吗啡的消耗量。
与关节外输注相比，关节内给予罗哌卡因并没有改善镇痛效果，但改善了第一次活动。关节内输注组疼痛强度高（VAS7-10）的发生率较低。两组的镇痛需求相似（47mg 和 49mg 吗啡）。未观察到术后伤口愈合并发症，也无毒性副作用。
与关节外给药相比，关节内持续输注罗哌卡因不能改善术后静息时的镇痛效果，但似乎可以降低第一次运动时高疼痛强度的发生率，因此可以预期在全膝关节置换术后 24 小时内改善活动度。
