Schwarzkopf Ran, Drexler Michael, Ma Michael W, Schultz Vanessa M, Le Khanhvan T, Rutenberg Tal Frenkel, Rinehart Joseph B
Division of Adult Reconstruction, Department of Orthopaedic Surgery, NYU Langone Medical Center Hospital For Joint Diseases, New York, New York.
Division of Orthopaedic Surgery, Sorasky Medical Center, Tel Aviv University, Tel Aviv, Israel.
J Arthroplasty. 2016 Aug;31(8):1702-5. doi: 10.1016/j.arth.2016.01.037. Epub 2016 Jan 30.
Postoperative pain after total knee arthroplasty (TKA) poses a major challenge. It delays mobilization, increases opioid consumption and side effects, and lengthens hospitalization. This challenge multiplies when treating an opioid-dependent population. We examined whether a novel suspended release local anesthetic, liposomal bupivacaine (LB) would improve pain control and decrease opioid consumption after TKA compared to a standard periarticular injection in opioid-dependent patients.
Thirty-eight patients undergoing TKA were randomly assigned to receive either a periarticular injection (PAI) with LB (n = 20) or with a standard PAI (including a combination of ropivacaine, clonidine, Toradol, Epinepherine, and saline; n = 18) as part of a multimodal pain management approach. All periarticular injections were done by a single surgeon. Perioperative treatment was similar between groups. Postoperative information regarding pain level was evaluated by a pain visual analog scale score. Postoperative opioid consumption was recorded.
After controlling baseline narcotic usage before surgery, no differences were found between groups in daily postoperative narcotic usage (P = .113), average daily pain score (P = .332), or maximum daily pain score (P = .881). However, when examining pain levels separately for each day, pain visual analog scale scores were reported higher in post operative day 1 in the LB group (P = .033).
LB was not found to be superior to standard PAI in opioid-dependent patients undergoing TKA. This patient population continues to present a challenge even with modern multimodal pain protocols.
全膝关节置换术（TKA）后的术后疼痛是一项重大挑战。它会延迟活动，增加阿片类药物的消耗量及副作用，并延长住院时间。在治疗阿片类药物依赖人群时，这一挑战会成倍增加。我们研究了一种新型缓释局部麻醉剂——脂质体布比卡因（LB）与标准关节周围注射相比，在阿片类药物依赖患者接受TKA后是否能改善疼痛控制并减少阿片类药物的消耗量。
38例接受TKA的患者被随机分配，作为多模式疼痛管理方法的一部分，接受关节周围注射（PAI），其中20例接受LB注射，18例接受标准PAI（包括罗哌卡因、可乐定、托拉朵尔、肾上腺素和生理盐水的组合）。所有关节周围注射均由一名外科医生完成。两组的围手术期治疗相似。通过疼痛视觉模拟量表评分评估术后疼痛水平的相关信息。记录术后阿片类药物的消耗量。
在控制术前基线麻醉药物使用量后，两组术后每日麻醉药物使用量（P = 0.113）、平均每日疼痛评分（P = 0.332）或每日最大疼痛评分（P = 0.881）均无差异。然而，当分别检查每天的疼痛水平时，LB组术后第1天的疼痛视觉模拟量表评分更高（P = 0.033）。
在接受TKA的阿片类药物依赖患者中，未发现LB优于标准PAI。即使采用现代多模式疼痛方案，这一患者群体仍然是一个挑战。
