Tammachote Nattapol, Kanitnate Supakit, Manuwong Sudsayam, Panichkul Phonthakorn
Department of Orthopaedics, Faculty of Medicine, Thammasat University, 99 Moo 18, Khlong Nueng, Khlong Luang, Pathumthani, 12120, Thailand.
Department of Anesthesiology, Faculty of Medicine, Thammasat University, 99 Moo 18, Khlong Nueng, Khlong Luang, Pathumthani, 12120, Thailand.
Eur J Orthop Surg Traumatol. 2018 May;28(4):667-675. doi: 10.1007/s00590-017-2110-x. Epub 2017 Dec 21.
Postoperative pain is one of the issues that concern most patients after total knee arthroplasty (TKA). Periarticular multimodal drug injection and single anesthetic agent injection have been shown to effectively reduce postoperative pain. The purpose of this study was to compare the efficacy between multimodal drug injection and single anesthetic drug injection in controlling pain after TKA using a double-blinded randomized controlled trial.
Sixty-four osteoarthritic patients who underwent primary TKA were randomized into two groups. The multimodal drug injection group (group M) received levobupivacaine 150 mg, ketorolac 30 mg and morphine 5 mg, while the single anesthetic drug injection group (group S) received only levobupivacaine 150 mg. The primary outcomes were pain level (VAS), quantity of opioid consumption (mg) and time to request the first dose of analgesic drug (min).
Multimodal drug injection provided lower pain level in the first 4 h after surgery (VAS rest: 30 vs 46, p = 0.02; VAS motion: 45 vs 66, p = 0.03). They consumed less morphine mostly in the first 8 h after surgery (5 vs 12 mg, p < 0.0001) and had approximately 2 h longer time to request the first dose of analgesic drug (254 vs 148 min, p = 0.02).
Multimodal drug injection decreases pain level, reduces morphine consumption in the early postoperative period and prolongs the analgesic effect compared to single anesthetic drug. One may consider using single anesthetic agent only in patients who have high risk of opioid or NSAIDs side effect.
术后疼痛是全膝关节置换术（TKA）后最令大多数患者担忧的问题之一。关节周围多模式药物注射和单一麻醉剂注射已被证明能有效减轻术后疼痛。本研究的目的是采用双盲随机对照试验比较多模式药物注射和单一麻醉药物注射在TKA后控制疼痛方面的疗效。
64例行初次TKA的骨关节炎患者被随机分为两组。多模式药物注射组（M组）接受左布比卡因150mg、酮咯酸30mg和吗啡5mg，而单一麻醉药物注射组（S组）仅接受左布比卡因150mg。主要结局指标为疼痛程度（视觉模拟评分法，VAS）、阿片类药物消耗量（mg）和首次要求使用镇痛药物的时间（分钟）。
多模式药物注射在术后4小时内提供了更低的疼痛程度（静息时VAS：30比46，p = 0.02；活动时VAS：45比66，p = 0.03）。他们在术后8小时内大多消耗了更少的吗啡（5mg比12mg，p < 0.0001），且首次要求使用镇痛药物的时间延长了约2小时（254分钟比148分钟，p = 0.02）。
与单一麻醉药物相比，多模式药物注射可降低疼痛程度，减少术后早期吗啡消耗量，并延长镇痛效果。对于有阿片类药物或非甾体抗炎药副作用高风险的患者，可考虑仅使用单一麻醉剂。
