Levitetz Department of Orthopaedic Surgery, Cleveland Clinic Florida, Weston, Florida.
Westside Regional Medical Center, Plantation, Florida.
J Arthroplasty. 2018 Jul;33(7S):S136-S141. doi: 10.1016/j.arth.2018.02.088. Epub 2018 Mar 12.
Total knee arthroplasty (TKA) can be associated with significant pain which can negatively impact outcomes. Multiple strategies have been employed to reduce pain. The aim of this study is to compare the effectiveness of 3 different pain management modalities after TKA that included (1) our standardized knee injection cocktail and oral acetaminophen, (2) liposomal bupivacaine periarticular injection and oral acetaminophen, and (3) our standardized knee injection cocktail and intravenous (IV) acetaminophen.
A prospective randomized clinical trial was conducted with 3 perioperative pain management regimes: oral acetaminophen and our standardized knee injection cocktail (standard group), oral acetaminophen and liposomal bupivacaine periarticular injection (LB group), and IV acetaminophen and our standardized knee injection cocktail (IVA group). Primary outcome measures included visual analog scale, total morphine equivalents, and the opioid-related symptoms distress scale at 24 and 48 hours postoperatively.
There were no significant differences on visual analog scale/opioid-related symptoms distress scale scores 24 hours after surgery. The LB group required significantly more narcotics (total morphine equivalents) than the standard (P = .025) and IVA groups (P = .032). No significant differences were observed on any of the outcomes measured at 48 hours after surgery.
Our data suggest that there is no added benefit in the routine use of IV acetaminophen or liposomal bupivacaine after TKA.
全膝关节置换术（TKA）可伴有明显疼痛，这可能对结果产生负面影响。已经采用了多种策略来减轻疼痛。本研究的目的是比较 TKA 后三种不同疼痛管理方式的效果，包括（1）我们的标准化膝关节注射鸡尾酒和口服对乙酰氨基酚，（2）局部注射包载布比卡因和口服对乙酰氨基酚，以及（3）我们的标准化膝关节注射鸡尾酒和静脉注射（IV）对乙酰氨基酚。
进行了一项前瞻性随机临床试验，有三种围手术期疼痛管理方案：口服对乙酰氨基酚和我们的标准化膝关节注射鸡尾酒（标准组）、口服对乙酰氨基酚和局部注射包载布比卡因（LB 组）以及 IV 注射对乙酰氨基酚和我们的标准化膝关节注射鸡尾酒（IVA 组）。主要观察指标包括术后 24 和 48 小时的视觉模拟评分、总吗啡等效物和阿片类药物相关症状困扰评分。
术后 24 小时，视觉模拟评分/阿片类药物相关症状困扰评分无显著差异。LB 组需要的麻醉性镇痛药（总吗啡等效物）明显多于标准组（P =.025）和 IVA 组（P =.032）。术后 48 小时，所有测量结果均无显著差异。
我们的数据表明，TKA 后常规使用 IV 对乙酰氨基酚或包载布比卡因并无额外获益。
