Liszka Henryk, Solecki Tomasz, Gądek Artur
Przegl Lek. 2016;73(9):615-20.
Severe postoperative pain is one of the causes of prolonged hospitalization, rehabilitation and complications after surgical treatment of distal radius fractures. Preemptive local anesthesia is effective in reduction of postoperative pain in general surgery, neurosurgery, gynecology and orthopedic surgery. The aim of the study was to assess the role and effectiveness of preoperative local anesthetic infiltration of the surgical site in open reduction and internal fixation (ORIF) of distal radius fractures under general anesthesia.
88 patients with acute distal radius intra-articular and unstable fractures were randomly assigned to receive preoperative infiltration of the surgical site with a mixture of local anesthetic agents or with saline. We measured the time from the fracture to surgery and intensity of pain at 4, 8, 12, 16, 24, 48 and 72 hours after the release of the tourniquet using a visual analogue scale (VAS). We noted all the side effects and the requirement for intravenous (IV) rescue analgesia. From analysis of chart review of their follow up visits at 2, 6 and 12 weeks we obtained DASH (Disabilities of the Arm, Shoulder and Hand) score, ROM (Range of Motion) of the wrist and grip strength of the hand.
The level of postoperative pain measured by the VAS scale decreased significantly during first 24 hours after surgery in the study group in comparison to the placebo group (p<0.05). We observed a positive correlation between the time elapsed between the fracture and surgery and the average VAS score in the study group. Chart review of follow up visits at 2, 6 and 12 weeks revealed significant decreased DASH score at 2 weeks and significant increased wrist flexion and extension at 2 and 6 weeks postoperatively. Six patients from the control and three subjects from the experimental group used rescue analgesia. We did not observe any side effects of the drugs. In one patient from the control group, we noted complex regional pain syndrome in late follow-up.
Preemptive local anesthesia is effective in reduction of postoperative pain after ORIF of distal radius fractures within first 24 hours. The effectiveness of preemptive local anesthesia decreases with the time elapsed between the fracture and operation. It is safe and reduces the use of rescue analgesia.
严重的术后疼痛是桡骨远端骨折手术治疗后住院时间延长、康复延迟及出现并发症的原因之一。术前局部麻醉在普通外科、神经外科、妇科及骨科手术中能有效减轻术后疼痛。本研究旨在评估全身麻醉下行桡骨远端骨折切开复位内固定术（ORIF）时，术前对手术部位进行局部麻醉药浸润的作用及效果。
88例急性桡骨远端关节内及不稳定骨折患者被随机分为两组，分别接受术前手术部位局部麻醉药混合液浸润或生理盐水浸润。使用视觉模拟评分法（VAS）测量从骨折到手术的时间以及松开止血带后4、8、12、16、24、48和72小时的疼痛强度。记录所有副作用及静脉（IV）解救镇痛的需求。通过对他们术后2、6和12周随访的病历审查分析，我们获得了上肢、肩部和手部功能障碍评分（DASH）、腕关节活动范围（ROM）和手部握力。
与安慰剂组相比，研究组术后24小时内用VAS量表测量的术后疼痛水平显著降低（p<0.05）。我们观察到研究组中骨折与手术之间的时间间隔与平均VAS评分呈正相关。术后2、6和12周随访病历审查显示，术后2周时DASH评分显著降低，术后2周和6周时腕关节屈伸活动显著增加。对照组6例患者和实验组3例患者使用了解救镇痛。我们未观察到药物的任何副作用。对照组1例患者在随访后期出现复杂性区域疼痛综合征。
术前局部麻醉在桡骨远端骨折切开复位内固定术后24小时内可有效减轻疼痛。术前局部麻醉的效果随骨折与手术之间时间间隔的延长而降低。它是安全的，并减少了解救镇痛药物的使用。
