Hinzpeter Jaime, Barrientos Cristián, Zamorano Álvaro, Martinez Álvaro, Palet Miguel, Wulf Rodrigo, Barahona Maximiliano, Sepúlveda Joaquín M, Guerra Matias, Bustamante Tamara, Del Campo Miguel, Tapia Eric, Lagos Nestor
Department of Orthopedic Surgery, University of Chile Clinical Hospital, Santos Dumont 999, Independencia, Santiago, 8380456, Chile.
Department of Orthopedic Surgery, Hospital San José, San José 1196, Independencia, Santiago, 8380419, Chile.
Toxicon. 2016 Sep 1;119:180-5. doi: 10.1016/j.toxicon.2016.06.010. Epub 2016 Jun 15.
Improvements in pain management techniques in the last decade have had a major impact on the practice of total knee arthroplasty (TKA). Gonyautoxin are phycotoxins, whose molecular mechanism of action is a reversible block of the voltage-gated sodium channels at the axonal level, impeding nerve impulse propagation. This study was designed to evaluate the clinical efficacy of Gonyautoxin infiltration, as a long acting pain blocker in TKA. Fifteen patients received a total dose of 40 μg of Gonyautoxin during the TKA operation. Postoperatively, all patients were given a standard painkiller protocol: 100 mg of intravenous ketoprofen and 1000 mg of oral acetaminophen every 8 hours for 3 days. The Visual Analog Scale (VAS) pain score and range of motion were recorded 12, 36, and 60 hours post-surgery. All patients reported pain of 2 or less on the VAS 12 and 36 hours post-surgery. Moreover, all scored were less than 4 at 60 hours post-surgery. All patients achieved full knee extension at all times. No side effects or adverse reactions to Gonyautoxin were detected in the follow-up period. The median hospital stay was 3 days. For the first time, this study has shown the effect of blocking the neuronal transmission of pain by locally infiltrating Gonyautoxin during TKA. All patients successfully responded to the pain control. The Gonyautoxin infiltration was safe and effective, and patients experienced pain relief without the use of opioids.
过去十年中疼痛管理技术的改进对全膝关节置换术（TKA）的实践产生了重大影响。膝沟毒素是一种藻毒素，其作用的分子机制是在轴突水平可逆性阻断电压门控钠通道，从而阻碍神经冲动的传播。本研究旨在评估膝沟毒素浸润作为TKA中一种长效疼痛阻滞剂的临床疗效。15例患者在TKA手术期间接受了总量为40μg的膝沟毒素。术后，所有患者均接受标准的止痛方案：静脉注射酮洛芬100mg，口服对乙酰氨基酚1000mg，每8小时一次，共3天。在术后12、36和60小时记录视觉模拟评分（VAS）疼痛评分和活动范围。所有患者在术后12和36小时的VAS疼痛评分均为2或更低。此外，所有患者在术后60小时的评分均低于4。所有患者在任何时候都能实现膝关节完全伸直。在随访期间未检测到对膝沟毒素的副作用或不良反应。中位住院时间为3天。本研究首次表明，在TKA期间局部浸润膝沟毒素可阻断疼痛的神经传递。所有患者对疼痛控制均有成功反应。膝沟毒素浸润安全有效，患者无需使用阿片类药物即可缓解疼痛。
