Kim Yong Sang, Kim Bom Soo, Koh Yong Gon, Lee Jin Woo
Department of Orthopaedic Surgery, Yonsei Sarang Hospital, 478-3, Bangbae-dong, Seocho-gu, Seoul 137-060, Republic of Korea.
Department of Orthopaedic Surgery, Inha University Graduate School of Medicine, 27, Inhang-ro, Jung-gu, Incheon 400-711, Republic of Korea.
J Orthop Sci. 2016 May;21(3):316-22. doi: 10.1016/j.jos.2016.02.002. Epub 2016 Feb 28.
Optimal management of postoperative pain is important to ensure patient comfort and functional improvement. Despite the frequent use of multimodal drug injection for pain control after orthopedic surgery, few studies have evaluated its use after supramalleolar osteotomy.
Supramalleolar osteotomy was performed in 62 patients (65 ankles). Thirty patients (31 ankles) were randomly assigned to receive multimodal drug injection (injection group) and 32 patients (34 ankles) were assigned to receive no multimodal drug injection (control group). The two groups were compared with regard to the degree of postoperative pain, the number of times patients pushed the patient-controlled analgesia (PCA) button, the total amount of fentanyl administered, and the frequency of additional diclofenac sodium injections.
The injection group had significant pain reduction during the first 36 postoperative hours compared to the control group. There were significant differences between the groups in the number of times that patients pushed the PCA button as well as the total amount of fentanyl administered up to 24 h postoperatively. The mean frequency of additional diclofenac sodium injections in the first 12 postoperative hours was significantly less in the injection group compared to that in the control group.
Multimodal drug injection was effective in reducing pain and decreasing both fentanyl and diclofenac sodium usage in patients undergoing supramalleolar osteotomy. Therefore, multimodal drug injection should be considered for improved pain control and patient comfort in the early postoperative period after supramalleolar osteotomy.
术后疼痛的优化管理对于确保患者舒适度和功能改善至关重要。尽管在骨科手术后频繁使用多模式药物注射来控制疼痛，但很少有研究评估其在踝关节上截骨术后的应用。
对62例患者（65个踝关节）实施了踝关节上截骨术。30例患者（31个踝关节）被随机分配接受多模式药物注射（注射组），32例患者（34个踝关节）被分配不接受多模式药物注射（对照组）。比较两组患者术后疼痛程度、患者按压患者自控镇痛（PCA）按钮的次数、芬太尼给药总量以及额外注射双氯芬酸钠的频率。
与对照组相比，注射组在术后最初36小时内疼痛明显减轻。两组患者按压PCA按钮的次数以及术后24小时内芬太尼给药总量存在显著差异。与对照组相比，注射组术后前12小时内额外注射双氯芬酸钠的平均频率明显更低。
多模式药物注射在减轻踝关节上截骨术患者的疼痛以及减少芬太尼和双氯芬酸钠用量方面有效。因此，在踝关节上截骨术后早期，应考虑采用多模式药物注射来改善疼痛控制和患者舒适度。
