Villatte Guillaume, Engels Emilien, Erivan Roger, Mulliez Aurélien, Caumon Nicolas, Boisgard Stéphane, Descamps Stéphane
Department of Orthopedics, Clermont-Ferrand University Hospital, 58 rue Montalembert, 63000, Clermont-Ferrand, France.
Laboratory C-Biosenss EA 4676, Clermont-Ferrand University, Université d'Auvergne, 63000, Clermont-Ferrand, France.
Int Orthop. 2016 Nov;40(11):2255-2260. doi: 10.1007/s00264-016-3133-3. Epub 2016 Feb 22.
Total hip arthroplasty (THA) is considered a painful procedure with significant blood loss. The aim of the this study was to determine whether local infiltration analgaesia (LIA) (with long-acting local anaesthetics and epinephrine) during THA could reduce acute postoperative pain, improve early recovery and reduce per- and postoperative bleeding.
One hundred and fifty patients scheduled for primary THA were randomised into two groups. The treatment group received LIA (ropivacaine with epinephrine), whereas the control group had no infiltration. Pain intensity was measured with a visual analogue scale (VAS) for the duration of hospital stay and analgaesic consumption. Length of hospital stay, time to get out of bed alone and the Western Ontario and McMaster Universities Osteoarthritis (WOMAC) Index at 3, 6 and 12 months were recorded to evaluate recovery. Per- and postoperative bleeding were evaluated using direct and indirect criteria (operative blood loss, haemoglobin, estimation of uncompensated blood loss and red blood cell transfusion).
Patients with LIA had significantly less pain during the first 24 h (p = 0.04). No significant differences were found in terms of analgaesic consumption (p = 0.57), early and delayed recovery or bleeding between groups.
Operative wound infiltration of LIA reduced acute pain after primary THA but did not improve recovery or influence per- and postoperative bleeding.
全髋关节置换术（THA）被认为是一种伴有大量失血的疼痛手术。本研究的目的是确定在THA期间进行局部浸润镇痛（LIA）（使用长效局部麻醉剂和肾上腺素）是否可以减轻术后急性疼痛、促进早期恢复并减少术中和术后出血。
150例计划进行初次THA的患者被随机分为两组。治疗组接受LIA（罗哌卡因加肾上腺素），而对照组未进行浸润。在住院期间使用视觉模拟量表（VAS）测量疼痛强度，并记录镇痛药物的消耗量。记录住院时间、独自下床时间以及3、6和12个月时的西安大略和麦克马斯特大学骨关节炎指数（WOMAC），以评估恢复情况。使用直接和间接标准（手术失血量、血红蛋白、估算的未代偿失血量和红细胞输注）评估术中和术后出血情况。
接受LIA的患者在最初24小时内疼痛明显减轻（p = 0.04）。在镇痛药物消耗量（p = 0.57）、早期和延迟恢复或两组之间的出血方面未发现显著差异。
LIA的手术伤口浸润可减轻初次THA后的急性疼痛，但并未改善恢复情况，也未影响术中和术后出血。
