Kuchálik Ján, Magnuson Anders, Lundin Anders, Gupta Anil
Department of Anaesthesiology and Intensive Care, Institution for Medicine and Health, Örebro University Hospital, Örebro, Sweden.
Clinical Epidemiology and Biostatistics Unit, Örebro University Hospital, Örebro, Sweden.
J Anesth. 2017 Dec;31(6):837-845. doi: 10.1007/s00540-017-2403-6. Epub 2017 Aug 30.
Local infiltration analgesia (LIA) is commonly used for postoperative pain management following total hip arthroplasty (THA). However, the long-term effects of the component drugs are unclear. The aim of our study was to investigate functional outcome, quality of life, chronic post-surgical pain, and adverse events in patients within 2 years of undergoing THA.
The study was a secondary analysis of data from a previous larger study. Eighty patients were randomized to receive either intrathecal morphine (Group ITM) or local infiltration analgesia (Group LIA) for pain management in a double-blind study. The parameters measured were patient-assessed functional outcome [using the Hip dysfunction and Osteo-arthritis Outcome Score (HOOS) questionnaire], health-related quality of life [using the European Quality of Life-5 dimensions (EQ-5D) questionnaire and the 36-Item Short Form Health Survey (SF-36) score], and pain using the numeric rating score (NRS), with persistent post-surgical pain having a NRS of > 3 or a HOOS pain sub-score of > 30. All complications and adverse events were investigated during the first 2 years after primary surgery.
Pain intensity and rescue analgesic consumption were similar between the groups after hospital discharge. No differences were found in HOOS or SF-36 score between the groups up to 6 months after surgery. A significant group × time interaction was seen in the EQ 5D form in favor of the LIA group. No between-group difference in persistent post-surgical pain was found at 3 or 6 months, or in adverse events up to 2 years after surgery.
Analysis of functional outcome, quality of life, and post-discharge surgical pain did not reveal significant differences between patients receiving LIA and those receiving ITM. LIA was found to be a safe technique for THA during the long-term follow-up. However, it should be noted that these conclusions are based on a limited number of patients.
局部浸润镇痛（LIA）常用于全髋关节置换术（THA）后的术后疼痛管理。然而，其组成药物的长期影响尚不清楚。本研究的目的是调查接受THA术后2年内患者的功能结局、生活质量、慢性术后疼痛及不良事件。
本研究是对先前一项更大规模研究的数据进行的二次分析。在一项双盲研究中，80例患者被随机分为两组，分别接受鞘内注射吗啡（鞘内吗啡组）或局部浸润镇痛（局部浸润镇痛组）以进行疼痛管理。测量的参数包括患者自我评估的功能结局[使用髋关节功能障碍和骨关节炎结局评分（HOOS）问卷]、健康相关生活质量[使用欧洲五维健康量表（EQ-5D）问卷和36项简短健康调查（SF-36）评分]，以及使用数字评分量表（NRS）评估的疼痛情况，术后持续疼痛定义为NRS>3或HOOS疼痛子评分>30。在初次手术后的前2年内对所有并发症和不良事件进行调查。
出院后两组间疼痛强度和补救性镇痛药使用量相似。术后6个月内两组间HOOS或SF-36评分无差异。EQ-5D量表显示存在显著的组×时间交互作用，有利于局部浸润镇痛组。术后3个月或6个月时，两组间持续术后疼痛无差异，术后2年内不良事件也无差异。
对功能结局、生活质量和出院后手术疼痛的分析未发现接受局部浸润镇痛的患者与接受鞘内注射吗啡的患者之间存在显著差异。在长期随访中，局部浸润镇痛被发现是一种用于全髋关节置换术的安全技术。然而，应注意这些结论是基于有限数量的患者得出的。
