Rahimzadeh Poupak, Faiz Seyed Hamid Reza, Ziyaeifard Mohsen, Niknam Keyvan
Department of Anesthesiology, Hazrat Rasul Medical Complex, Tehran, Iran.
Resident of Anesthesiology, Tehran University of Medical Sciences, Tehran, Iran.
J Res Med Sci. 2013 Aug;18(8):632-6.
Elective knee surgery for repairing anterior cruciate ligament is usually associated with moderate to severe postoperative pain, and, therefore, selecting appropriate analgesia can considerably facilitate pain control and patient's discharge. This study was designed to compare the analgesic effectiveness of administration of ropivacaine or ropivacaine plus ketamine on pain control and improvement of muscle weakness after anterior cruciate ligament repair in adults.
A double-blind randomized study which performed in Operating room and Sixty six patients with American Society of Anesthesiologists health status I to II that underwent elective knee surgery for repairing anterior cruciate ligament under spinal anesthesia were enrolled. Patients were randomly allocated to receive either ropivacaine 0.2% or an equivalent volume of ropivacaine 0.1% plus 1.0 mg/kg ketamine via continuous femoral block with pump infusion. The patients were familiarized with a 10-point verbal analog scale. Quadriceps muscle weakness and sedation score were assessed based on relevant scales. Parameters assessment were obtained from all patients immediately after PACU entrance, and postoperative assessment was performed at 4, 8, 12, 16, 20, 24, 30, 36, 42, and 48 h after the operation.
The data of 31 patients who received ropivacaine and of 33 patients in ketamine-ropivacaine group were eligible for analysis. Visual analogue scale (VAS) scores differed at various time points after surgery, with higher scores in patients who received concomitant ketamine and ropivacaine (P < 0.05). The degree of quadriceps muscle weakness was similar between the groups at the different time points. Patients in ropivacaine group rated better quality of pain control with appropriate sedation in comparison with the patients in ketamine/ropivacaine group.
Our study shows that the addition of a ketamine 1 mg/kg to 0.1% ropivacaine via pump infusion after repairing anterior cruciate ligament could not improve pain control and muscle weakness.
择期膝关节前交叉韧带修复手术通常会伴有中度至重度的术后疼痛，因此，选择合适的镇痛方法可极大地促进疼痛控制及患者出院。本研究旨在比较罗哌卡因或罗哌卡因加氯胺酮给药对成人前交叉韧带修复术后疼痛控制及肌肉无力改善的镇痛效果。
一项双盲随机研究在手术室进行，纳入了66例美国麻醉医师协会健康状况为I至II级、在脊髓麻醉下接受择期膝关节前交叉韧带修复手术的患者。患者被随机分配通过泵注持续股神经阻滞接受0.2%罗哌卡因或等量的0.1%罗哌卡因加1.0mg/kg氯胺酮。让患者熟悉10分数字评分量表。根据相关量表评估股四头肌无力和镇静评分。所有患者在进入麻醉后恢复室（PACU）后立即获得参数评估，并在术后4、8、12、16、20、24、30、36、42和48小时进行术后评估。
31例接受罗哌卡因治疗的患者和33例氯胺酮-罗哌卡因组患者的数据符合分析要求。术后不同时间点的视觉模拟量表（VAS）评分存在差异，接受氯胺酮和罗哌卡因联合治疗的患者评分更高（P<0.05）。不同时间点两组间股四头肌无力程度相似。与氯胺酮/罗哌卡因组患者相比，罗哌卡因组患者对疼痛控制质量和适当镇静的评分更高。
我们的研究表明，前交叉韧带修复术后通过泵注在0.1%罗哌卡因中添加1mg/kg氯胺酮并不能改善疼痛控制和肌肉无力。
