J Med Assoc Thai. 2014 Dec;97(12):1332-7.
To study post-operative pain and blood loss after intraoperative periarticular injection with the multimodal drugs diclofenac, adrenaline, marcaine (bupivacaine) and morphine in total knee arthroplasty.
A prospective randomized controlled trial of knee osteoarthritis patients age more than 55 years undergoing total knee arthroplasty at Maharat Nakhon Ratchasima hospital from January 2011 through June 2012 was performed. A group receiving intra-operative periarticular injections was compared to a control group receiving no injections. Half of a group of forty-two patients, 2 males and 40 females, average age 67.9 years (range 57-84 years), were randomly assigned to receive the periarticular injection (the injection group), the others to the control group. Pain was measured by two methods: visual analog score at 6, 12, 24 and 48 hours post-operation and by patient controlled analgesia (PCA) measuring the daily amount of intravenous morphine used. The amount of blood loss post operation (in the redivac drain), degree of knee flexion, time to onset of assisted ambulation, length of hospital stay and any complications were also analyzed.
The mean VAS at 6 and 12 hours post operation of the injection group were 2.67 and 2.48, whereas the values for the control group were 6.10 and 4.95, respectively (p < 0.05). Mean quantities of morphine used by PCA by the injection group during the first day was 9.43 mg, significantly lower than the 18.81 mg used by the control group. Average blood loss of the injection group at 263.8 ml was also significantly below the 362.1 ml of the control group (p < 0.05). The degree of knee flexion, time to onset of assist ambulation, length of hospital stay and complications, however were not significantly different between the groups.
Multimodal drugs, periarticular injections consisting of diclofenac, adrenaline, Marcaine plus a patient controled anesthetic machine (PCA) with morphine can significantly reduce post-operative pain and blood loss in total knee arthroplasty without significant adverse effects.
研究在全膝关节置换术中关节周围注射多模式药物双氯芬酸、肾上腺素、布比卡因和吗啡后的术后疼痛及失血量。
对2011年1月至2012年6月在玛哈叻呵叻府医院接受全膝关节置换术的55岁以上膝骨关节炎患者进行一项前瞻性随机对照试验。将接受术中关节周围注射的组与未接受注射的对照组进行比较。42例患者（2例男性，40例女性，平均年龄67.9岁，范围57 - 84岁）中，一半被随机分配接受关节周围注射（注射组），另一半为对照组。通过两种方法测量疼痛：术后6、12、24和48小时的视觉模拟评分，以及通过患者自控镇痛（PCA）测量每日静脉使用吗啡的量。还分析了术后失血量（引流瓶中）、膝关节屈曲程度、开始辅助行走的时间、住院时间及任何并发症。
注射组术后6小时和12小时的平均视觉模拟评分分别为2.67和2.48，而对照组分别为6.10和4.95（p < 0.05）。注射组第一天通过PCA使用的吗啡平均量为9.43mg，显著低于对照组的18.81mg。注射组平均失血量为263.8ml，也显著低于对照组的362.1ml（p < 0.05）。然而，两组之间膝关节屈曲程度、开始辅助行走的时间、住院时间及并发症并无显著差异。
由双氯芬酸、肾上腺素、布比卡因组成的关节周围注射多模式药物加上带吗啡的患者自控麻醉机（PCA）可显著减少全膝关节置换术后的疼痛和失血量，且无显著不良反应。
