Iwakiri Kentaro, Minami Yoshito, Ohta Yoichi, Kobayashi Akio
Department of Orthopaedic Surgery, Shiraniwa Hospital Joint Arthroplasty Center, Ikoma City, Nara, Japan.
Department of Orthopaedic Surgery, Osaka City University Graduate School of Medicine, Osaka City, Osaka, Japan.
J Arthroplasty. 2017 Jun;32(6):1839-1844. doi: 10.1016/j.arth.2016.12.034. Epub 2016 Dec 27.
The periarticular multimodal cocktail injection including morphine is currently commonly used to treat postoperative pain after total knee arthroplasty (TKA). Despite its analgesic effect, it is frequently reported to cause nausea and vomiting, which are adverse effects of opioids. This study aimed to assess the efficacy of morphine as a component of a multimodal cocktail injection for providing postoperative analgesia and alleviating swelling in patients who underwent TKA.
This is a prospective, single-center, randomized controlled trial involving 102 patients scheduled for unilateral TKA. A mixture of steroids, local anesthetics, nonsteroidal anti-inflammatory drugs, and epinephrine with or without morphine (10 mg) was injected to randomly assigned patients. Postoperative assessment was performed with all attending personnel and patients blinded to group assignment. Visual analog scale of pain, range of motion, nausea numerical rating scale, number of patients with vomiting, total dose of antiemetic drugs used, thigh swelling, the Western Ontario and McMaster Universities Osteoarthritis Index score, and adverse outcomes were compared between groups on postoperative days.
Visual analog scale scores did not differ between the 2 groups at any postoperative time point. The nausea numerical rating scale scores during the postoperative period from 30 min to 9 h, the number of vomiting episodes, and the total dose of antiemetic drugs administered were significantly higher in the morphine group. The thigh girth, Western Ontario and McMaster Universities Osteoarthritis Index, and the incidence of complications were not different between groups.
The results of this study suggested that addition of morphine to the multimodal cocktail injection is not effective for relieving postoperative pain, alleviating swelling, or improving range of motion, and results in nausea and vomiting.
包括吗啡在内的关节周围多模式鸡尾酒式注射目前常用于治疗全膝关节置换术（TKA）后的术后疼痛。尽管其具有镇痛作用，但经常有报道称会引起恶心和呕吐，这是阿片类药物的不良反应。本研究旨在评估吗啡作为多模式鸡尾酒式注射的一种成分，在为接受TKA的患者提供术后镇痛和减轻肿胀方面的疗效。
这是一项前瞻性、单中心、随机对照试验，纳入了102例计划进行单侧TKA的患者。将类固醇、局部麻醉剂、非甾体抗炎药和肾上腺素的混合物，含或不含吗啡（10毫克），注射给随机分配的患者。术后评估由所有参与人员进行，且患者和研究人员均对分组情况不知情。比较两组术后不同时间点的视觉模拟疼痛评分、关节活动范围、恶心数字评分量表、呕吐患者数量、使用的止吐药物总剂量、大腿肿胀情况、西安大略和麦克马斯特大学骨关节炎指数评分以及不良结局。
两组在任何术后时间点的视觉模拟评分均无差异。吗啡组术后30分钟至9小时期间的恶心数字评分量表得分、呕吐发作次数以及使用的止吐药物总剂量均显著更高。两组之间的大腿围度、西安大略和麦克马斯特大学骨关节炎指数以及并发症发生率没有差异。
本研究结果表明，在多模式鸡尾酒式注射中添加吗啡对缓解术后疼痛、减轻肿胀或改善关节活动范围无效，且会导致恶心和呕吐。
