Department of Orthopaedic Surgery, Murup Hospital, Gyeongnam, South Korea.
Yokosuka Municipal Hospital, Kanagawa, Japan.
Arthroscopy. 2014 Oct;30(10):1261-8. doi: 10.1016/j.arthro.2014.04.104. Epub 2014 Jul 3.
The purpose of this study was to evaluate the efficacy of periarticular multimodal drug injection after medial opening-wedge high tibial osteotomy regarding the postoperative pain level.
From January 2011 to January 2012, 70 patients underwent medial opening-wedge high tibial osteotomy. Thirty-five patients were randomly assigned to receive no injection (group I), and 35 patients were assigned to receive periarticular multimodal drug injection (group II). These 2 groups were compared regarding the postoperative pain level, frequency of additional nonsteroidal anti-inflammatory drug injections, total amount of patient-controlled analgesia, and number of times that patients pushed the patient-controlled analgesia button at each time interval. Statistical results were based on multivariate analysis of variance and repeated-measures analyses.
Multivariate analysis of variance of mean visual analog scale (VAS) scores over the 2-week postoperative period showed statistical significance (P < .001). Repeated-measures analysis yielded a statistically significant difference (P = .001) for the time-by-treatment interaction, showing a clear periarticular multimodal drug injection benefit over time based on VAS scores. In addition, the mean number of times that patients pushed the patient-controlled analgesia button differed significantly between groups over time (P = .01). The VAS scores, frequency of additional nonsteroidal anti-inflammatory drug injections, mean number of times that patients pushed the patient-controlled analgesia button, and mean total amount of fentanyl consumption differed significantly within each group over time (P < .001 for all variables). However, the frequency of additional nonsteroidal anti-inflammatory drug injections and mean total amount of fentanyl consumption did not differ significantly between groups over time (P = .822, P = .529, and P = .282). Opioid- and injection-related complications were not found.
This prospective randomized study shows that intraoperative periarticular multimodal drug injections in patients undergoing medial opening-wedge high tibial osteotomy for unicompartmental osteoarthritis of the knee could result in significant reductions in VAS scores at 2 weeks postoperatively.
Level I, high-quality randomized controlled trial with statistically significant differences.
本研究旨在评估内侧开放楔形胫骨高位截骨术后关节周围多模式药物注射对术后疼痛水平的疗效。
2011 年 1 月至 2012 年 1 月，70 例患者接受内侧开放楔形胫骨高位截骨术。35 例患者随机分为不注射组（I 组），35 例患者分为关节周围多模式药物注射组（II 组）。比较两组患者术后疼痛水平、非甾体抗炎药追加注射次数、患者自控镇痛总用量及各时间点按压患者自控镇痛按钮次数。统计结果基于多变量方差分析和重复测量分析。
术后 2 周内平均视觉模拟评分（VAS）的多变量方差分析显示具有统计学意义（P<.001）。重复测量分析显示时间-治疗交互作用有统计学差异（P=.001），表明 VAS 评分随时间推移，关节周围多模式药物注射具有明显的获益。此外，两组患者在各时间点按压患者自控镇痛按钮的次数差异有统计学意义（P=.01）。VAS 评分、非甾体抗炎药追加注射次数、患者按压患者自控镇痛按钮次数和芬太尼总用量在各时间点的组内差异均有统计学意义（所有变量 P<.001）。然而，两组患者在各时间点的非甾体抗炎药追加注射次数和芬太尼总用量差异无统计学意义（P=.822、P=.529、P=.282）。未发现阿片类药物和注射相关并发症。
本前瞻性随机研究表明，膝关节单间室骨关节炎患者行内侧开放楔形胫骨高位截骨术时，术中关节周围多模式药物注射可使术后 2 周 VAS 评分显著降低。
Ⅰ级，高质量随机对照试验，差异具有统计学意义。
