Kasture Sarang, Saraf Hrushikesh
MIMER Medical College, Pune, India.
Shashwat Multispecialty Hospital, Pune, India.
J Orthop Surg (Hong Kong). 2015 Dec;23(3):287-9. doi: 10.1177/230949901502300304.
To compare the efficacy of epidural versus intra-articular infusion analgesia following total knee replacement (TKR).
25 men and 50 women aged 55 to 75 (mean, 67) years who underwent primary TKR by a single surgeon were randomised and consented to receive either epidural (n=35) or intra-articular (n=40) infusion analgesia for 48 hours at 5 ml/ hr. All patients also received intravenous aqueous diclofenac 50 mg twice a day. Patients were assessed 6 hourly for visual analogue score (VAS) for pain to determine the analgesic effect. Complications such as paraesthesia in the lower limbs, hypotension, urinary retention, and abdominal distension were recorded, as was the rehabilitation progress with respect to the time to stand, climb stairs, use of commode chair, and discharge.
The epidural and intra-articular infusion groups were comparable with respect to age, sex, weight, and operating time, as was the analgesic efficacy within 48 hours of TKR. Patients with epidural infusion analgesia had a higher complication rate in terms of hypotension (51.4% vs. 22.5%, p=0.015) and troublesome paraesthesia in the lower limbs (45.7% vs. 12.5%, p=0.028), and a trend of higher abdominal distension rate (20% vs. 5%, p=0.073). Patients with intra-articular infusion analgesia were able to stand/ walk earlier (2.08 vs. 2.54 days, p<0.001). The 2 groups did not differ significantly in the time needed to climb stairs, use of commode chair, and discharge.
The efficacy of epidural and intraarticular infusion analgesia was comparable. Intra-articular infusion was associated with fewer complications and earlier rehabilitation.
比较全膝关节置换术（TKR）后硬膜外与关节内输注镇痛的疗效。
25名男性和50名年龄在55至75岁（平均67岁）的女性接受了由单一外科医生进行的初次TKR手术，他们被随机分组并同意接受硬膜外（n = 35）或关节内（n = 40）输注镇痛，持续48小时，速度为5毫升/小时。所有患者还每天两次静脉注射50毫克双氯芬酸水合物。每6小时对患者进行疼痛视觉模拟评分（VAS）评估以确定镇痛效果。记录下肢感觉异常、低血压、尿潴留和腹胀等并发症，以及站立时间、爬楼梯、使用坐便器和出院时间等康复进展情况。
硬膜外和关节内输注组在年龄、性别、体重和手术时间方面具有可比性，TKR术后48小时内的镇痛效果也相当。硬膜外输注镇痛的患者在低血压（51.4%对22.5%，p = 0.015）和下肢严重感觉异常（45.7%对12.5%，p = 0.028）方面的并发症发生率更高，腹胀率也有升高趋势（20%对5%，p = 0.073）。关节内输注镇痛的患者能够更早站立/行走（2.08天对2.54天，p < 0.001）。两组在爬楼梯、使用坐便器和出院所需时间方面无显著差异。
硬膜外和关节内输注镇痛的疗效相当。关节内输注并发症更少，康复更早。
