Koehler Daniel, Marsh J Lawrence, Karam Matthew, Fruehling Catherine, Willey Michael
1Department of Orthopaedic Surgery and Rehabilitation, University of Iowa Hospitals and Clinics, Iowa City, Iowa.
J Bone Joint Surg Am. 2017 Mar 15;99(6):512-519. doi: 10.2106/JBJS.16.00733.
Multimodal analgesia inclusive of periarticular injection with a local anesthetic agent has been rapidly assimilated, with demonstrated safety and efficacy, into the care of patients undergoing elective lower-extremity arthroplasty. The present study was performed to evaluate the efficacy and safety of a surgical-site, multimodal drug injection for postoperative pain control following operative management of femoral fractures.
There were 102 patients undergoing operative intervention (plate fixation, intramedullary device, or arthroplasty) for a broad range of femoral fracture patterns who were prospectively randomized either to receive an intraoperative, surgical-site injection into the superficial and deep tissues containing ropivacaine, epinephrine, and morphine or to receive no injection. Visual analog scale (VAS) scores were recorded at regular intervals as the primary outcome measure. Narcotic consumption and medication-related side effects were also monitored.
The injection group demonstrated significantly lower VAS scores (p < 0.05) than the control cohort in the recovery room and at the 4, 8, and 12-hour postoperative time points. The median score (and interquartile range) was 1.6 (0 to 4.0) for the injection group and 3.2 (1.3 to 5.7) for the control group immediately postoperatively, 1.0 (0 to 3.0) for the injection group and 5.0 (2.0 to 7.0) for the control group at 4 hours, 2.0 (0 to 4.0) for the injection group and 5.0 (2.0 to 6.8) for the control group at 8 hours, and 3.5 (0 to 5.0) for the injection group and 5.0 (2.0 to 8.0) for the control group at 12 hours. Additionally, narcotic consumption was significantly lower (p = 0.007) in the injection group (5.0 mg [1.3 to 8.0 mg]) compared with the control group (9.7 mg [3.9 to 15.6 mg]) over the first 8 hours following the surgical procedure. No cardiac or central nervous system toxicity was observed secondary to infiltration of the local anesthetic.
Surgical-site injection with a multimodal analgesic cocktail provides improved pain control and reduces narcotic utilization over the first postoperative day, with no observed adverse effects attributable to the local injection, across a diverse orthopaedic trauma population undergoing operative intervention for femoral fractures.
Therapeutic Level I. See Instructions for Authors for a complete description of levels of evidence.
包括关节周围注射局部麻醉剂在内的多模式镇痛已迅速被采用，其安全性和有效性已在接受择期下肢关节置换术的患者护理中得到证实。本研究旨在评估手术部位多模式药物注射对股骨骨折手术治疗后术后疼痛控制的有效性和安全性。
102例因多种股骨骨折类型接受手术干预（钢板固定、髓内装置或关节置换术）的患者被前瞻性随机分为两组，一组术中在包含罗哌卡因、肾上腺素和吗啡的浅、深组织进行手术部位注射，另一组不进行注射。定期记录视觉模拟量表（VAS）评分作为主要结局指标。同时监测麻醉药物消耗量和药物相关副作用。
在恢复室以及术后4、8和12小时时间点，注射组的VAS评分显著低于对照组（p < 0.05）。术后即刻，注射组的中位数评分（及四分位间距）为1.6（0至4.0），对照组为3.2（1.3至5.7）；术后4小时，注射组为1.0（0至3.0），对照组为5.0（2.0至7.0）；术后8小时，注射组为2.0（0至4.0），对照组为5.0（2.0至6.8）；术后12小时，注射组为3.5（0至5.0），对照组为5.0（2.0至8.0）。此外，在手术后的前8小时，注射组的麻醉药物消耗量（5.0 mg [1.3至8.0 mg]）显著低于对照组（9.7 mg [3.9至15.6 mg]）（p = 0.007）。未观察到因局部麻醉剂浸润引起的心脏或中枢神经系统毒性。
对于接受股骨骨折手术干预的不同骨科创伤患者群体，手术部位注射多模式镇痛鸡尾酒可在术后第一天改善疼痛控制并减少麻醉药物使用，且未观察到局部注射引起的不良反应。
治疗性I级。有关证据水平的完整描述，请参阅作者指南。
