Binici Bedir Eylem, Kurtulmuş Tuhan, Başyiğit Selma, Bakır Uğur, Sağlam Necdet, Saka Gürsel
Department of Anesthesiology and Reanimation, Bilecik State Hospital, Bilecik, Turkey.
Department of Orthopedics and Traumatology, Ümraniye Training and Research Hospital, İstanbul, Turkey.
Acta Orthop Traumatol Turc. 2014;48(1):73-9. doi: 10.3944/AOTT.2014.3256.
The aim of this study was to compare the effects of epidural analgesia with infiltration analgesia in postoperative pain control for total knee arthroplasty.
Thirty patients (28 female, 2 male; mean age: 69.37±5.11 years, range: 61 to 80 years) undergoing total knee arthroplasty between May 2011 and September 2011 were randomly divided into 2 groups. All patients received spinal anesthesia with bupivacaine. Postoperative analgesia of 72 ml 0.9% NaCl + 48 ml bupivacaine (1 ml = 5 mg, total 120 ml) was administered throughout 24 hours to Group 1 (n=15) by epidural catheter and to Group 2 (n=15) by ON-Q infiltration pump. Groups were compared based on the Bromage scores and visual analog scale (VAS), blood pressure, postoperative analgesia requirement and side effects.
Demographic data were similar in both groups. Rates of additional analgesia requirement at the postoperative 60th minute and 2nd hour were significantly higher in Group 2 than Group 1 (p<0.05). Rates of nausea-vomiting at the postoperative 60th minute and 2nd hour were significantly higher in Group 1 than Group 2 (p<0.05 and p<0.01, respectively). Bromage scores at 60 minutes and 2 hours was significantly higher in Group 1 than in Group 2 (p<0.01). Mean VAS scores at 60 minutes and 2 hours were significantly higher in Group 2 than Group 1 (p<0.05). While a statistically significant difference was found between systolic arterial pressure measurements at 60 minutes (p<0.05), there was no significant difference in diastolic arterial pressure and peak heart rate.
Although the analgesic effect of local infiltration is provided later than by epidural analgesia, the same level of pain control can be achieved with initial additional analgesia. Local infiltration is superior to epidural analgesia in respect of few side effects and early mobilization.
本研究旨在比较硬膜外镇痛与局部浸润镇痛对全膝关节置换术后疼痛控制的效果。
2011年5月至2011年9月期间接受全膝关节置换术的30例患者（28例女性，2例男性；平均年龄：69.37±5.11岁，范围：61至80岁）被随机分为2组。所有患者均接受布比卡因腰麻。第1组（n = 15）通过硬膜外导管在24小时内给予72 ml 0.9%氯化钠+48 ml布比卡因（1 ml = 5 mg，共120 ml）进行术后镇痛，第2组（n = 15）通过ON-Q局部浸润泵给药。根据 Bromage评分、视觉模拟量表（VAS）、血压、术后镇痛需求和副作用对两组进行比较。
两组的人口统计学数据相似。术后第60分钟和第2小时，第2组额外镇痛需求率显著高于第1组（p<0.05）。术后第60分钟和第2小时，第1组恶心呕吐率显著高于第2组（分别为p<0.05和p<0.01）。第1组60分钟和2小时的 Bromage评分显著高于第2组（p<0.01）。第2组60分钟和2小时的平均VAS评分显著高于第1组（p<0.05）。虽然在60分钟时收缩动脉压测量值之间存在统计学显著差异（p<0.05），但舒张压和心率峰值无显著差异。
虽然局部浸润的镇痛效果比硬膜外镇痛出现得晚，但通过初始额外镇痛可达到相同的疼痛控制水平。局部浸润在副作用少和早期活动方面优于硬膜外镇痛。
