2nd Department of Anaesthesiology, School of Medicine, Attikon University Hospital, University of Athens, 1 Rimini Street, 12462, Athens, Greece,
Arch Orthop Trauma Surg. 2013 Nov;133(11):1607-12. doi: 10.1007/s00402-013-1849-8. Epub 2013 Sep 14.
Epidural and intravenous patient-controlled analgesia (PCA) are established methods for pain relief after total hip arthroplasty (THA). Periarticular infiltration is an alternative method that is gaining ground due to its simplicity and safety. Our study aims to assess the efficacy of periarticular infiltration in pain relief after THA.
Sixty-three patients undergoing THA under spinal anaesthesia were randomly assigned to receive postoperative analgesia with continuous epidural infusion with ropivacaine (epidural group), intraoperative periarticular infiltration with ropivacaine, clonidine, morphine, epinephrine and corticosteroids (infiltration group) or PCA with morphine (PCA group). PCA morphine provided rescue analgesia in all groups. We recorded morphine consumption, visual analog scale (VAS) scores at rest and movement, blood loss from wound drainage, mean arterial pressure (MAP) and adverse effects at 1, 6, 12, 24 h postoperatively.
Morphine consumption at all time points, VAS scores at rest, 6, 12 and 24 h and at movement, 6 and 12 h postoperatively were lower in infiltration group compared to PCA group (p < 0.05), but did not differ between infiltration and epidural group. There was no difference in adverse events in all groups. At 24 h, MAP was higher in the PCA group (p < 0.05) and blood loss was lower in the infiltration group (p < 0.05).
In our study periarticular infiltration was clearly superior to PCA with morphine after THA, providing better pain relief and lower opioid consumption postoperatively. Infiltration seems to be equally effective to epidural analgesia without having the potential side effects of the latter.
硬膜外和静脉患者自控镇痛（PCA）是全髋关节置换术（THA）后缓解疼痛的既定方法。关节周围浸润是一种替代方法，由于其简单性和安全性而得到越来越多的应用。我们的研究旨在评估关节周围浸润在 THA 后缓解疼痛的效果。
63 例行椎管内麻醉下 THA 的患者随机分为三组：接受连续硬膜外输注罗哌卡因（硬膜外组）、术中关节周围浸润罗哌卡因、可乐定、吗啡、肾上腺素和皮质类固醇（浸润组）或 PCA 吗啡（PCA 组）进行术后镇痛。所有组均使用 PCA 吗啡进行解救镇痛。我们记录了吗啡用量、静息和运动时的视觉模拟评分（VAS）、伤口引流的失血量、平均动脉压（MAP）和术后 1、6、12、24 小时的不良反应。
在所有时间点，包括静息时、术后 6、12 和 24 小时，以及运动时 6 和 12 小时，浸润组的吗啡用量、VAS 评分均低于 PCA 组（p<0.05），但与硬膜外组无差异。所有组的不良反应无差异。在 24 小时时，PCA 组的 MAP 更高（p<0.05），浸润组的失血量更少（p<0.05）。
在我们的研究中，关节周围浸润在 THA 后明显优于 PCA 吗啡，提供了更好的疼痛缓解和术后阿片类药物用量减少。浸润似乎与硬膜外镇痛同样有效，而没有后者的潜在副作用。
