Department of Orthopedic Surgery, Kochi University, 185-1 Oko-cho, Nankoku, Kochi, 783-8505, Japan,
Knee Surg Sports Traumatol Arthrosc. 2014 Jul;22(7):1638-43. doi: 10.1007/s00167-013-2367-5. Epub 2013 Jan 11.
Intraoperative local infiltration analgesia has gained increasing popularity in joint replacement surgery. Because there is considerable variation among drug combinations, analgesic effects of each drug are not well understood. The purpose of this study was to clarify the efficacy of the addition of steroid to local anaesthetics in local infiltration analgesia during total knee arthroplasty.
Forty patients were randomly allocated to the steroid or control group. Patients in the steroid group received peri-articular injection of ropivacaine, dexamethasone and isepamicin, while dexamethasone was omitted from the analgesic mixture in the control group. Primary outcome was pain severity at rest using 100 mm visual analogue scale.
Pain severity in the steroid group was lower than control group and there were significant differences between groups at post-operative day 1 and 3. Reduction in post-operative pain was associated with a decrease in serum C-reactive protein and interleukin 6 in drainage fluid. The number of patients who were able to perform straight leg raise within post-operative day 2 was 15/20 in the steroid group, which was significantly higher than the control group 5/20.
Adding steroid to local anaesthetics in local infiltration analgesia reduced inflammation both locally and systemically, resulting in significant early pain relief and rapid recovery in total knee arthroplasty.
局部浸润镇痛在关节置换术中越来越受欢迎。由于药物组合存在很大差异，因此每种药物的镇痛效果并不清楚。本研究的目的是阐明在全膝关节置换术中局部浸润镇痛时加入类固醇对局部麻醉剂的疗效。
40 名患者随机分配到类固醇组或对照组。类固醇组患者接受关节周围注射罗哌卡因、地塞米松和异帕米星，而对照组的镇痛混合物中则不添加地塞米松。主要结局是使用 100mm 视觉模拟量表评估休息时的疼痛严重程度。
类固醇组的疼痛严重程度低于对照组，术后第 1 天和第 3 天两组之间存在显著差异。术后疼痛减轻与引流液中血清 C 反应蛋白和白细胞介素 6 的减少有关。在术后第 2 天能够进行直腿抬高的患者中，类固醇组为 15/20，明显高于对照组的 5/20。
在局部浸润镇痛中加入类固醇可减轻局部和全身的炎症反应，从而显著减轻全膝关节置换术后的早期疼痛并促进快速康复。
