Department of Orthopaedics, Walter Reed National Military Medical Center, 8901 Wisconsin Ave, Bethesda, MD, 20889, USA.
APEX Orthopedic and Sports Medicine Overland Park, Overland Park, KS, USA.
Knee Surg Sports Traumatol Arthrosc. 2018 Aug;26(8):2536-2541. doi: 10.1007/s00167-018-4874-x. Epub 2018 Feb 16.
A newer formulation of bupivacaine, encapsulated within carrier molecules, has garnered attention for its role in providing extended post-operative analgesia. The purpose was to evaluate the addition of liposomal bupivacaine to fascia iliaca blockade during hip arthroscopy.
Retrospective cohort study of patients undergoing hip arthroscopy with a pre-operative fascia iliaca blockade with either liposomal bupivacaine (Group 1; 266mg + 20 cc 0.5% plain bupivacaine) or bupivacaine (Group 2; 40 cc 0.25% plain bupivacaine). All patients received standardized pre-operative oral pain medications. The primary outcome was the defense veteran pain rating scale (DVPRS). Secondary outcomes included duration of hospital admission, PACU opioid use, PACU pain scores, and duration of nerve blockade.
Thirty-eight males and 30 females, mean age of 33 years (range 14-56). There was no difference in pre-operative DVPRS between the groups (n.s.). There was no difference in post-operative DVPRS pain scores at POD0 (3.7 vs. 3.9, n.s.), POD1 (4.2 vs. 3.8, n.s.), POD2 (4.2 vs. 3.7, n.s.), POD3 (3.9 vs. 3.7, n.s.) or POD14 (2.2 vs. 2.4, n.s.). Group 1 trended towards longer mean total hospital admission time (872 vs. 822 min, n.s.), and greater mean morphine equivalents administered in the PACU (33 vs. 29 mg, n.s.). 68% of patients in group 1 reported continued anterior thigh numbness at POD3, compared to 34% in group 2 (p = 0.008).
Despite the advertised benefits of prolonged post-operative analgesia using liposomal bupivacaine, there were no significant differences in post-operative pain scores or PACU opioid consumption. Our results support that acceptable pain scores are successfully achieved at all time periods with the use of multimodal analgesia including fascia iliaca blockade despite the type of pain medication administered.
III.
一种新的布比卡因制剂，被包裹在载体分子内，因其在提供术后延长镇痛方面的作用而受到关注。目的是评估在髋关节镜检查中向髂筋膜阻滞中添加脂质体布比卡因的效果。
对接受髋关节镜检查并进行术前髂筋膜阻滞的患者进行回顾性队列研究，阻滞药物分别为脂质体布比卡因（组 1；266mg+20 cc 0.5% 布比卡因）或布比卡因（组 2；40 cc 0.25% 布比卡因）。所有患者均接受标准化术前口服止痛药。主要结局是防御老兵疼痛评分量表（DVPRS）。次要结局包括住院时间、PACU 阿片类药物使用、PACU 疼痛评分和神经阻滞持续时间。
38 名男性和 30 名女性，平均年龄 33 岁（14-56 岁）。两组患者术前 DVPRS 无差异（n.s.）。两组患者术后第 0 天（3.7 对 3.9，n.s.）、第 1 天（4.2 对 3.8，n.s.）、第 2 天（4.2 对 3.7，n.s.）、第 3 天（3.9 对 3.7，n.s.）和第 14 天（2.2 对 2.4，n.s.）的术后 DVPRS 疼痛评分无差异。组 1 的平均总住院时间（872 对 822 分钟，n.s.）和 PACU 中给予的平均吗啡当量（33 对 29 毫克，n.s.）较长。组 1 有 68%的患者在第 3 天仍有大腿前侧麻木感，而组 2 有 34%（p=0.008）。
尽管使用脂质体布比卡因有延长术后镇痛的优势，但在术后疼痛评分或 PACU 阿片类药物使用方面没有显著差异。我们的结果支持，在使用包括髂筋膜阻滞在内的多模式镇痛的情况下，在所有时间段内都能成功获得可接受的疼痛评分，而与使用的镇痛药物类型无关。
III 级。
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