Department of Orthopedic Surgery, Kochi University, 185-1 Oko-cho, Nankoku, Kochi, 783-8505, Japan,
Knee Surg Sports Traumatol Arthrosc. 2013 Dec;21(12):2680-4. doi: 10.1007/s00167-012-2004-8. Epub 2012 Apr 11.
Although intra-operative local infiltration analgesia has gained increasing popularity in joint replacement surgery, it is not clear whether postoperative local infusion analgesia using an indwelling catheter provides clinically important additional effects. We, therefore, conducted a randomized controlled trial to clarify the efficacy of the originally developed local infusion analgesia technique in total knee arthroplasty.
Forty patients were randomly allocated to the local infusion analgesia or control group. Patients in the local infusion analgesia group received intermittent bolus intra-articular injection of analgesics consisting of ropivacaine, dexamethasone, and isepamicin until postoperative 48 h. Primary outcome was pain severity at rest using 100-mm visual analogue scale.
Pain severity in patients of the local infusion analgesia group was lower than control group, and there were significant differences between groups at POD1 (p = 0.025) and POD3 (p = 0.007). Reduction of postoperative pain was associated with a decrease in C-reactive protein level and earlier achievement of straight leg raise. In addition, postoperative drain volume was reduced in the local infusion analgesia group.
Although larger studies are needed to examine its safety, the local infusion analgesia alone provided clinically significant analgesic effects and rapid recovery in total knee arthroplasty.
尽管术中局部浸润镇痛在关节置换术中越来越受欢迎，但术后使用留置导管进行局部输注镇痛是否能提供临床重要的附加效果尚不清楚。因此，我们进行了一项随机对照试验，以明确我们最初开发的全膝关节置换术局部输注镇痛技术的疗效。
40 名患者被随机分配到局部输注镇痛组或对照组。局部输注镇痛组患者接受间歇性关节内注射罗哌卡因、地塞米松和异帕米星镇痛剂，直至术后 48 小时。主要结局是使用 100mm 视觉模拟评分法评估的静息时疼痛严重程度。
局部输注镇痛组患者的疼痛严重程度低于对照组，两组在术后第 1 天（p=0.025）和第 3 天（p=0.007）差异有统计学意义。术后疼痛减轻与 C 反应蛋白水平降低和直腿抬高更早实现有关。此外，局部输注镇痛组术后引流减少。
尽管需要更大的研究来检查其安全性，但单独使用局部输注镇痛在全膝关节置换术中提供了有临床意义的镇痛效果和快速康复。
