Isik Cengiz, Demirhan Abdullah, Yetis Tevfik, Okmen Korgun, Sarman Hakan, Tekelioglu Umit Yasar, Duran Turan
Department of Orthopedics and Traumatology, Faculty of Medicine, Abant İzzet Baysal University Medical School, Abant İzzet Baysal University, 14280, Gölköy, Bolu, Turkey,
Knee Surg Sports Traumatol Arthrosc. 2015 Sep;23(9):2721-6. doi: 10.1007/s00167-014-2962-0. Epub 2014 Mar 27.
To evaluate the efficacy of intraarticular injection of ketamine or ketamine plus levobupivacaine on post-operative analgesia in patients undergoing arthroscopic meniscectomy.
A prospective, randomized, double-blind study was performed on 60 patients aged 18-65 years who planned to undergo elective arthroscopic meniscectomy. The patients were divided into three groups: the ketamine group (n = 20) received 1.0 mg/kg of intraarticular ketamine in 20 ml of normal saline, the ketamine-levobupivacaine group (n = 20) received 0.5 mg/kg of intraarticular ketamine plus 50.0 mg of 0.25 % levobupivacaine in 20 ml of normal saline, and the control group (n = 20) received 20 ml of intraarticular normal saline. A visual analogue scale (VAS) was used to determine the efficacy of analgesia at 1, 2, 4, 6, 8, 12, and 24 h post-operatively.
There were statistically significant differences in the median VAS scores among the three groups according to Bonferroni adjustment at all time points (p < 0.01), with the exception of 6 and 24 h post-operatively. The median VAS scores at 1, 2, and 4 h post-operatively were higher in the control group than in the two treatment groups (p < 0.001). The median VAS scores in the control group at 1, 2, 4, 6, 8, and 12 h post-operatively and those in the ketamine group at 4, 8, and 12 h post-operatively were significantly higher than those in the ketamine-levobupivacaine group (p < 0.05).
Intraarticular ketamine provides effective post-operative analgesia. Addition of intraarticular levobupivacaine to ketamine may provide better amelioration of pain after outpatient arthroscopic meniscectomy.
评估关节腔内注射氯胺酮或氯胺酮联合左旋布比卡因对接受关节镜半月板切除术患者术后镇痛的效果。
对60例年龄在18 - 65岁、计划接受择期关节镜半月板切除术的患者进行了一项前瞻性、随机、双盲研究。患者被分为三组：氯胺酮组（n = 20）在20 ml生理盐水中接受1.0 mg/kg关节腔内氯胺酮注射；氯胺酮-左旋布比卡因组（n = 20）在20 ml生理盐水中接受0.5 mg/kg关节腔内氯胺酮加50.0 mg 0.25%左旋布比卡因注射；对照组（n = 20）接受20 ml关节腔内生理盐水注射。采用视觉模拟评分法（VAS）在术后1、2、4、6、8、12和24小时确定镇痛效果。
根据Bonferroni校正，三组在所有时间点的VAS评分中位数存在统计学显著差异（p < 0.01），术后6小时和24小时除外。术后1、2和4小时对照组的VAS评分中位数高于两个治疗组（p < 0.001）。对照组术后1、2、4、6、8和12小时的VAS评分中位数以及氯胺酮组术后4、8和12小时的VAS评分中位数显著高于氯胺酮-左旋布比卡因组（p < 0.05）。
关节腔内注射氯胺酮可提供有效的术后镇痛。在氯胺酮中加入关节腔内左旋布比卡因可能会更好地缓解门诊关节镜半月板切除术后的疼痛。
