Imani Farnad, Entezary Saeidreza, Razi Mohammad, Jafarian Ali Akbar, Yousefshahi Fardin, Etemadi Hasan, Safari Saeid
Pain Research Center, Iran University of Medical Sciences, Tehran, Iran ; Department of Anesthesiology and Pain Medicine, Rasoul Akram Medical Center,, Iran University of Medical Sciences, Tehran, Iran.
Department of Anesthesiology and Pain Medicine, Rasoul Akram Medical Center,, Iran University of Medical Sciences, Tehran, Iran.
Anesth Pain Med. 2015 Feb 19;5(1):e27470. doi: 10.5812/aapm.27470. eCollection 2015 Feb.
Arthroscopic knee surgeries have a painful postoperative course, which often necessitates acute pain management. Among different analgesia techniques, Intra-articular injection is the technique of choice for many pain specialists, based on its confined effect to the surgical site (knee), lack of systemic effects and promotion of safe early ambulation.
The aim of this study was to compare analgesic effects of intra-articular meperidine, bupivacaine 0.5% or their combination after knee arthroscopic surgery.
Sixty ASA class I-II patients' candidates for arthroscopy knee surgery enrolled in a randomized double blind study to receive either 20 mL of bupivacaine 0.5%; 100 mg meperidine (diluted in normal saline) or bupivacaine 0.5% along with 100 mg meperidine. A written informed consent was obtained from all patients. Postoperative analgesia duration, VAS at 2, 6, 12 and 24 hours, the first analgesic request time, total fentanyl consumption in first 24 hours, patients' satisfaction and adverse effects were recorded.
The bupivacaine-meperidine group had better duration of postoperative analgesia (P = 0.001), latter first analgesic request (P ≤ 0.001), lower total fentanyl consumption in first 24 hours after the operation (P = 0.001), less mean VAS at 2 hours (P = 0.001) and more patients' overall satisfaction (P = 0.01) compared with each medication alone. VAS at 6, 12 and 24 postoperative hours were not different between the groups of study. No adverse effects were observed.
Although postoperative intra-articular meperidine is a better alternative for bupivacaine, their combination could improve their analgesic effects compared with each other alone.
膝关节镜手术术后疼痛剧烈，通常需要进行急性疼痛管理。在不同的镇痛技术中，关节腔内注射因其对手术部位（膝关节）的局限性作用、无全身影响以及有助于安全早期活动，是许多疼痛专家的首选技术。
本研究旨在比较膝关节镜手术后关节腔内注射哌替啶、0.5%布比卡因或两者联合使用的镇痛效果。
60例拟行膝关节镜手术的ASA I-II级患者纳入一项随机双盲研究，分别接受20 mL 0.5%布比卡因；100 mg哌替啶（用生理盐水稀释）或0.5%布比卡因加100 mg哌替啶。所有患者均签署了书面知情同意书。记录术后镇痛持续时间、术后2、6、12和24小时的视觉模拟评分（VAS）、首次镇痛需求时间、术后24小时内芬太尼总用量、患者满意度及不良反应。
与单独使用每种药物相比，布比卡因-哌替啶组术后镇痛持续时间更长（P = 0.001），首次镇痛需求时间更晚（P≤0.001），术后24小时内芬太尼总用量更低（P = 0.001），术后2小时平均VAS更低（P = 0.001），患者总体满意度更高（P = 0.01）。各研究组术后6、12和24小时的VAS无差异。未观察到不良反应。
虽然术后关节腔内注射哌替啶是布比卡因的较好替代方案，但两者联合使用比单独使用时镇痛效果更佳。
