Kang Chan, Lee Gi-Soo, Kim Sang-Bum, Won You-Gun, Lee Jeong-Kil, Jung You-Sun, Cho Hyung-June
Department of Orthopaedic Surgery, Chungnam National University School of Medicine, Republic of Korea.
Department of Orthopedic Surgery, Konyang University College of Medicine, Daejeon, Republic of Korea; Konyang University Myunggok Medical Research Institute, Daejeon, Republic of Korea.
Foot Ankle Surg. 2018 Dec;24(6):521-524. doi: 10.1016/j.fas.2017.06.006. Epub 2017 Jun 24.
We performed a prospective study to evaluate and compare the effectiveness of postoperative pain control methods after bone surgery in the foot and ankle.
Among the patients who underwent foot and ankle surgery from June 2014 to September 2015 with an ultrasound-guided nerve block, 84 patients who fully completed a postoperative pain survey were enrolled. An opioid patch (fentanyl patch, 25mg) was applied in group A (30 patients). Diluted anesthetic (0.2% ropivacaine, 30ml) was injected into the sciatic nerve once, about 12h after the preoperative nerve block, in group B (27 patients). Periodic intramuscular injection of an analgesic (ketorolac [Tarasyn], 30mg) was performed in group C (27 patients). The visual analogue scale (VAS) pain scores at 6, 12, 18, 24, and 48h after surgery were checked, and the complications of all methods were monitored.
The mean VAS pain score was lower in group B, with a statistically significant difference (P<.05) between groups A, B, and C at 12 and 18h after surgery. Four patients in group A experienced nausea and vomiting; however, no other patients complained of any complications or adverse effects.
The ultrasound-guided injection of a diluted anesthetic into the sciatic nerve seemed to be the most useful method for controlling pain in the acute phase after bone surgery in the foot and ankle. The injection of the diluted anesthetic once on the evening of the day of surgery resulted in less postoperative pain in the patients.
II.
我们进行了一项前瞻性研究，以评估和比较足踝部骨手术后疼痛控制方法的有效性。
在2014年6月至2015年9月接受超声引导下神经阻滞的足踝手术患者中，纳入84例完全完成术后疼痛调查的患者。A组（30例患者）应用阿片类药物贴片（芬太尼贴片，25mg）。B组（27例患者）在术前神经阻滞后约12小时，将稀释的麻醉剂（0.2%罗哌卡因，30ml）注入坐骨神经一次。C组（27例患者）定期肌内注射镇痛药（酮咯酸[Tarasyn]，30mg）。检查术后6、12、18、24和48小时的视觉模拟评分（VAS）疼痛评分，并监测所有方法的并发症。
B组的平均VAS疼痛评分较低，术后12和18小时，A、B、C组之间存在统计学显著差异（P<0.05）。A组有4例患者出现恶心和呕吐；然而，没有其他患者抱怨任何并发症或不良反应。
超声引导下向坐骨神经注射稀释的麻醉剂似乎是控制足踝部骨手术后急性期疼痛最有效的方法。在手术当天晚上注射一次稀释的麻醉剂可使患者术后疼痛减轻。
II级。
