Sivapurapu Vijayalakshmi, Murugharaj Shishir Suranigi, Venkata Sai Saran Panathula
Department of Anaesthesiology, Indira Gandhi Medical College and Research Institute, Puducherry, India.
Department of Orthopaedics, Pondicherry Institute of Medical Sciences, Puducherry, India.
J Anaesthesiol Clin Pharmacol. 2017 Jul-Sep;33(3):391-396. doi: 10.4103/joacp.JOACP_257_16.
Arthroscopic anterior cruciate ligament reconstruction (ACLR) is one of the most common knee surgeries done worldwide today. It involves immense pain at sites of graft harvest, tibial, and femoral tunnels, thereby delaying recovery and increased patient morbidity, and delayed rehabilitation. Various drugs and combination of drugs administered intra-articularly have been studied for analgesic efficacy. Our study gives an insight if there is any added advantage of additives morphine or clonidine to bupivacaine when compared to administering bupivacaine alone.
After obtaining the Institute Ethics Committee approval, ninety American Society of Anesthesiology I-II patients undergoing arthroscopic ACLR under spinal anesthesia were randomly assigned to one of three groups (Group B - bupivacaine alone 0.25%, Group BM - bupivacaine 0.25% with morphine 5 mg, Group BC - bupivacaine 0.25% with clonidine 150 mcg). At the end of procedure, 20 mL of the respective drug was administered intra-articularly and postoperative time duration to rescue analgesia, 24 h analgesic requirement, visual analog scale (VAS) score findings at rest and on movement were observed.
The mean duration of time to request for first rescue analgesia in minutes was significantly longer in Group BC 341.55 (103.66 SD) with < 0.001. The VAS scores at that time point were least in Group BM 6.1 (1.7 SD), but not statistically significant. The 24 h analgesic consumption was least in Group B 2.24 (0.79 SD), but not statistically significant.
Combination of bupivacaine and clonidine administered intra-articularly provided a longer duration of analgesia though the quality of analgesia was comparable between the three groups.
关节镜下前交叉韧带重建术（ACLR）是目前全球范围内最常见的膝关节手术之一。该手术在取腱部位、胫骨和股骨隧道处会引起剧烈疼痛，从而延迟恢复并增加患者发病率以及延迟康复。人们已经研究了多种关节腔内注射的药物及其联合用药的镇痛效果。我们的研究旨在探讨与单独使用布比卡因相比，在布比卡因中添加吗啡或可乐定是否具有额外优势。
获得机构伦理委员会批准后，将90例在脊髓麻醉下接受关节镜下ACLR的美国麻醉医师协会I-II级患者随机分为三组之一（B组 - 单独使用0.25%布比卡因，BM组 - 0.25%布比卡因加5 mg吗啡，BC组 - 0.25%布比卡因加150 mcg可乐定）。手术结束时，向关节腔内注射20 mL相应药物，并观察术后至首次补救镇痛的时间、24小时镇痛需求、静息和活动时的视觉模拟评分（VAS）结果。
BC组首次补救镇痛的平均时间（分钟）显著更长，为341.55（标准差103.6），P < 0.001。此时BM组的VAS评分最低，为6.1（标准差1.7），但无统计学意义。24小时镇痛药物消耗量B组最少，为2.24（标准差0.79），但无统计学意义。
关节腔内注射布比卡因和可乐定的联合用药提供了更长时间的镇痛效果，尽管三组之间的镇痛质量相当。
