Nakai Tsuyoshi, Tamaki Masashi, Nakamura Toshiyuki, Nakai Takaaki, Onishi Atsunori, Hashimoto Kunihiko
Department of Orthopaedic Surgery, Itami City Hospital, 1-100 Koyaike, Itami, Japan.
J Orthop. 2013 Mar 17;10(2):92-4. doi: 10.1016/j.jor.2013.02.001. eCollection 2013.
Measures for pain management after total knee arthroplasty (TKA) are important for early improvement in the quality of life after operation and early postoperative rehabilitation. We investigated the benefits and safety analgesic effect of locally injected drugs around the total knee prosthesis.
60 patients undergoing TKA for osteoarthritis were divided randomly into three groups.Group A (20 knees; control group), this group did not receive multimodal drug cocktailtherapy; group B (21 knees), received intra-articular injection of a multimodal drug cocktail; and group C (19 knees), received localperiarticular injection of a multimodal drug cocktail. All analgesics administered in the first 24 h after surgery were recorded. The evaluation items included assessment of pain using a 100-point visual analogue scale (VAS) after the patients awoke on the day of the operation and on postoperative day 1, the dose of diclofenac sodium suppository, the number of days for acquiring assisted ambulation with a walking cane, and side effects. Assessment of flexion angles was conducted at postoperativeweek 1 and at theconclusion of the study.
The VAS scores on the day of surgery and the amounts of diclofenac sodium used indicated good pain relief in groups B and C; the level of pain control was higher in group C than in group B. No cardiac or central nervous system toxicity was observed.
Periarticular injection with multimodal drugs can significantly reduce the requirements for analgesia, with no apparent risks, following TKA.
全膝关节置换术（TKA）后疼痛管理措施对于术后早期生活质量改善及早期康复至关重要。我们研究了在全膝关节假体周围局部注射药物的镇痛效果及安全性。
60例因骨关节炎接受TKA的患者随机分为三组。A组（20膝；对照组），该组未接受多模式药物鸡尾酒疗法；B组（21膝），接受关节腔内注射多模式药物鸡尾酒；C组（19膝），接受局部关节周围注射多模式药物鸡尾酒。记录术后前24小时内使用的所有镇痛药。评估项目包括患者术后当天醒来及术后第1天使用100分视觉模拟量表（VAS）评估疼痛、双氯芬酸钠栓剂剂量、使用手杖辅助行走的天数及副作用。在术后第1周和研究结束时进行屈曲角度评估。
手术当天的VAS评分及双氯芬酸钠用量表明B组和C组疼痛缓解良好；C组疼痛控制水平高于B组。未观察到心脏或中枢神经系统毒性。
TKA术后关节周围注射多模式药物可显著降低镇痛需求，且无明显风险。
