CEISAM, CNRS UMR 6230, University of Nantes, Nantes, France; RMeS-lab, INSERM UMR 1229, University of Nantes, Nantes, France.
RMeS-lab, INSERM UMR 1229, University of Nantes, Nantes, France; INSERM, UMS 016, CNRS 3556, Structure Fédérative de Recherche François Bonamy, SC3M facility, CHU Nantes, Université de Nantes, Nantes, France; Université de Nantes, UFR Odontologie, Nantes, F-44042, France.
J Pain. 2018 Oct;19(10):1169-1180. doi: 10.1016/j.jpain.2018.04.014. Epub 2018 May 15.
Postoperative pain after bone reconstruction is a serious complication that could jeopardize the global success of a surgery. This pain must be controlled and minimized during the first 3 to 4 postoperative days to prevent it from becoming chronic. In this study, a critical-size bone defect was created at the femoral distal end of rats and filled by an injectable calcium phosphate cement (CPC) loaded or not with local anesthetics (bupivacaine or ropivacaine). A functional evaluation of the gait was performed using the CatWalk system to compare the postoperative pain relief enhanced by the different CPCs after such a bone filling surgery. The results demonstrated significant pain relief during the short-term postoperative period, as shown by the print area and intensity parameters of the operated paw. At 24hours, the print area decreased by 65%, 42%, and 24%, and the intensity decreased by 25%, 9%, and 1% for unloaded, ropivacaine-loaded, and bupivacaine-loaded CPCs, respectively, compared with the preoperative values. Bupivacaine-loaded CPC provided an earlier return to full functional recovery than ropivacaine-loaded CPC. Moreover, the CPCs retained their biologic and mechanical properties. For all these reasons, anesthetic-loaded CPCs could be part of the global pain management protocol after bone reconstruction surgery such as iliac crest bone grafting procedures.
Bupivacaine-loaded CPC provided an earlier return to full gait function than ropivacaine-loaded CPC, with preserved bone filling properties. Such analgesic CPCs deserve further in vivo investigation and may be part of the global pain management protocol after bone reconstruction or bone augmentation surgery such as iliac crest bone grafting.
骨重建术后疼痛是一种严重的并发症，可能危及手术的整体成功。这种疼痛必须在术后 3 至 4 天内得到控制和减轻，以防止其发展为慢性疼痛。在这项研究中，在大鼠股骨远端创建了临界尺寸的骨缺损，并通过注射可吸收磷酸钙骨水泥（CPC）填充，其中加载或不加载局部麻醉剂（布比卡因或罗哌卡因）。使用 CatWalk 系统对步态进行功能评估，以比较在这种骨填充手术后不同 CPC 增强的术后疼痛缓解。结果显示，在术后短期，通过受影响的爪子的印迹面积和强度参数，明显缓解了疼痛。在 24 小时时，未加载、罗哌卡因加载和布比卡因加载 CPC 的印迹面积分别减少了 65%、42%和 24%，强度分别减少了 25%、9%和 1%，与术前值相比。布比卡因加载 CPC 比罗哌卡因加载 CPC 更早地恢复到完全功能恢复。此外，CPC 保留了其生物和机械性能。出于所有这些原因，在骨重建手术后（如髂嵴骨移植手术）的整体疼痛管理方案中，可以考虑使用载有麻醉剂的 CPC。
与罗哌卡因加载 CPC 相比，布比卡因加载 CPC 更早地恢复到完全步态功能，同时保留了骨填充性能。这种镇痛 CPC 值得进一步的体内研究，并可能成为骨重建或骨增强手术后（如髂嵴骨移植）整体疼痛管理方案的一部分。
