围手术期使用加巴喷丁可减少全膝关节置换术联合周围神经阻滞患者术后24小时的阿片类药物消耗量，并改善住院期间的康复情况，但对出院后的结局无影响。

Perioperative gabapentin reduces 24 h opioid consumption and improves in-hospital rehabilitation but not post-discharge outcomes after total knee arthroplasty with peripheral nerve block.

作者信息

Clarke H A, Katz J, McCartney C J L, Stratford P, Kennedy D, Pagé M G, Awad I T, Gollish J, Kay J

机构信息

Department of Anaesthesia and Pain Management, Toronto General Hospital, Toronto, ON, Canada Department of Anaesthesia and Department of Anaesthesia, University of Toronto, Toronto, ON, Canada

Department of Anaesthesia and Pain Management, Toronto General Hospital, Toronto, ON, Canada Department of Anaesthesia, University of Toronto, Toronto, ON, Canada Department of Psychology, York University, Toronto, ON, Canada.

出版信息

Br J Anaesth. 2014 Nov;113(5):855-64. doi: 10.1093/bja/aeu202. Epub 2014 Jun 30.

DOI:10.1093/bja/aeu202

PMID:24980426

Abstract

BACKGROUND

This study was designed to determine whether a 4 day perioperative regimen of gabapentin added to celecoxib improves in-hospital rehabilitation and physical function on postoperative day 4 and 6 weeks and 3 months after total knee arthroplasty (TKA).

METHODS

After Research Ethics Board approval and informed consent, 212 patients were enrolled in a randomized, double-blinded, placebo-controlled study. Two hours before surgery, patients received celecoxib 400 mg p.o. and were randomly assigned to receive either gabapentin 600 mg or placebo p.o. Two hours later, patients received femoral, sciatic nerve blocks, and spinal anaesthesia. After operation, patients received gabapentin 200 mg or placebo three times per day (TID) for 4 days. All patients also received celecoxib 200 mg q12 h for 72 h and i.v. patient-controlled analgesia for 24 h. Pain and function were assessed at baseline, during hospitalization, on postoperative day 4 (POD4), and 6 weeks and 3 months after surgery.

RESULTS

The gabapentin group used less morphine in the first 24 h after surgery [G=38.3 (29.5 mg), P=48.2 (29.4 mg)] (P<0.0125) and had increased knee range of motion compared with the placebo group in-hospital (P<0.05). There were no differences between groups in favour of the gabapentin group for pain or physical function on POD 4 [95% confidence interval (CI): pain: -1.4, 0.5; function: -6.3, 2.0], 6 weeks (95% CI: pain: 0.1, 1.9; function: -0.2, 6.5) or 3 months (95% CI: pain: -0.2, 1.7; function: -2.2, 4.3) after TKA.

CONCLUSIONS

In the context of celecoxib, spinal anaesthesia, femoral and sciatic nerve blocks, a dose of gabapentin 600 mg before operation followed by 4 days of gabapentin 200 mg TID decreased postoperative analgesic requirements and improved knee range of motion after TKA. Gabapentin provided no improvement in pain or physical function on POD4 and 6 weeks or 3 months after surgery.

摘要

背景

本研究旨在确定围手术期4天加用加巴喷丁的塞来昔布方案是否能改善全膝关节置换术（TKA）后第4天、6周和3个月时的院内康复及身体功能。

方法

经研究伦理委员会批准并获得知情同意后，212例患者被纳入一项随机、双盲、安慰剂对照研究。手术前两小时，患者口服400mg塞来昔布，并随机分配口服600mg加巴喷丁或安慰剂。两小时后，患者接受股神经、坐骨神经阻滞及脊髓麻醉。术后，患者每天三次口服200mg加巴喷丁或安慰剂，共4天。所有患者还接受72小时每天两次每次200mg塞来昔布及24小时静脉自控镇痛。在基线、住院期间、术后第4天（POD4）、术后6周及3个月时评估疼痛和功能。

结果

与安慰剂组相比，加巴喷丁组术后前24小时吗啡用量更少[加巴喷丁组=38.3（29.5mg），安慰剂组=48.2（29.4mg）]（P<0.0125），且住院期间膝关节活动范围增加（P<0.05）。在TKA术后第4天[95%置信区间（CI）：疼痛：-1.4，0.5；功能：-6.3，2.0]、6周（95%CI：疼痛：0.1，1.9；功能：-0.2，6.5）或3个月（95%CI：疼痛：-0.2，1.7；功能：-2.2，4.3）时，两组在疼痛或身体功能方面均无有利于加巴喷丁组的差异。