Orthopaedic Outcomes Assessment Unit, Musgrave Park Hospital, Stockmans Lane, Belfast, BT9 7JB, Northern Ireland, UK.
Clin Orthop Relat Res. 2012 Jul;470(7):1958-65. doi: 10.1007/s11999-012-2241-7. Epub 2012 Jan 24.
BACKGROUND: Periarticular infiltration of local anesthetic, NSAIDs, and adrenaline have been reported to reduce postoperative pain, improve mobility, and reduce hospital stay for patients having THAs, but available studies have not determined whether local anesthetic infiltration alone achieves similar improvements. QUESTIONS: We therefore asked whether periarticular injection of a local anesthetic during THA reduced postoperative pain and opioid requirements and improved postoperative mobility. METHODS: We randomized 96 patients to either treatment (n = 50) or control groups (n = 46). Before wound closure, the treatment group received local infiltration of 160 mL of levobupivacaine with adrenaline. The control group received no local infiltration. We assessed postoperative morphine consumption and pain during the 24 hours after surgery. Mobilization was assessed 24 hours postoperatively with supine-to-sit and sit-to-stand transfers, timed 10-m walk test, and timed stair ascent and descent. Patients and assessing physiotherapists were blind to study status. RESULT: We observed no differences in postoperative morphine consumption, time to ascend and descend stairs, or ability to transfer between treatment and control groups. The treatment group reported more pain 7 to 12 hours postoperatively, but there were no differences in pain scores between groups at all other postoperative intervals. The treatment group showed increased postoperative walking speed greater than 6 m, but not greater than 10 m, compared with the control group. CONCLUSIONS: Periarticular infiltration of local anesthetic during THA did not reduce postoperative pain or length of hospital stay and did not improve early postoperative mobilization.
背景:局部麻醉剂、非甾体抗炎药和肾上腺素的关节周围浸润已被报道可减少人工髋关节置换术(THA)患者的术后疼痛、提高活动能力并减少住院时间,但现有研究尚未确定单独使用局部麻醉浸润是否可实现类似的改善。
问题:因此,我们询问在 THA 期间进行关节周围注射局部麻醉剂是否可减轻术后疼痛和阿片类药物需求并改善术后活动能力。
方法:我们将 96 名患者随机分为治疗组(n = 50)和对照组(n = 46)。在伤口关闭前,治疗组接受 160 毫升左旋布比卡因加肾上腺素的局部浸润。对照组未接受局部浸润。我们评估了术后 24 小时内的吗啡消耗量和疼痛情况。术后 24 小时评估了仰卧位到坐位和坐位到站位转移、10 米计时步行测试以及上下楼梯的时间。患者和评估理疗师对研究状态均不知情。
结果:我们未观察到治疗组和对照组在术后吗啡消耗量、上下楼梯时间或转移能力方面存在差异。治疗组在术后 7 至 12 小时报告的疼痛更多,但在所有其他术后时间间隔,两组的疼痛评分均无差异。与对照组相比,治疗组的术后行走速度增加,大于 6 米,但不大于 10 米。
结论:THA 期间关节周围局部麻醉浸润并未减轻术后疼痛或住院时间,也未改善术后早期活动能力。
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