Greimel Felix, Maderbacher Günther, Baier Clemens, Schwarz Timo, Zeman Florian, Meissner Winfried, Grifka Joachim, Benditz Achim
Department of Orthopedics, University Medical Center Regensburg, Asklepios Klinikum Bad Abbach, Bad Abbach, Germany.
Center for Clinical Studies, University Medical Center of Regensburg, Regensburg, Germany.
J Knee Surg. 2019 Oct;32(10):953-959. doi: 10.1055/s-0038-1672156. Epub 2018 Oct 6.
In the recent past, numerous studies evaluating local infiltration analgesia (LIA) with controversial results have been reported. Efforts have been made to improve patients' outcome regarding operation techniques and material, as well as pain management and anesthetic methods. In this study, postoperative pain management and patient satisfaction were evaluated in patients undergoing total knee replacement surgery with or without intraoperative LIA. Within the context of the "Quality Improvement in Postoperative Pain Management" (QUIPS) project, parameters were collected on the first postoperative day. All patients included in this study underwent primary knee replacement surgery with general anesthesia. Parameters were compared after performing a 1:1 matched-pair analysis within 14 orthopaedic departments. Pain levels and pain management satisfaction were measured using the numerous rating scales, and pain medication use was compared. From 2010 to 2015, 2,789 patients who underwent primary knee arthroplasty with general anesthesia were evaluated within the project, of whom a total of 846 patients could be compared after performing a matched-pair analysis. Pain scores were significantly better in the LIA group ( = 0.019 for activity pain, = 0.043 for maximum pain, < 0.001 for minimum pain), but pain management satisfaction was not superior ( = 0.083). Patients with LIA required less opioids in the recovery room ( = 0.048), while nonopioid medication did not differ significantly ( = 0.603). At the ward, 24 hours postoperatively, no significant difference in the use for nonopioids ( = 0.789) could be measured, whereas patients in the LIA group received significantly more opioids ( < 0.001). Although LIA achieved improvement in pain score outcome, and a comparable patient satisfaction level in the immediate postoperative course, the use of LIA in knee arthroplasty, controversially discussed in the current literature, was not able to reduce the need for opioid pain medication in this study.
最近，已有多项评估局部浸润镇痛（LIA）的研究报告，但结果存在争议。人们已在手术技术和材料、疼痛管理及麻醉方法等方面做出努力，以改善患者的治疗效果。在本研究中，对接受或未接受术中LIA的全膝关节置换手术患者的术后疼痛管理和患者满意度进行了评估。在“术后疼痛管理质量改进”（QUIPS）项目背景下，于术后第一天收集参数。本研究纳入的所有患者均接受全身麻醉下的初次膝关节置换手术。在14个骨科科室进行1:1配对分析后比较参数。使用多种评分量表测量疼痛程度和疼痛管理满意度，并比较止痛药物的使用情况。2010年至2015年期间，该项目对2789例接受全身麻醉下初次膝关节置换术的患者进行了评估，其中846例患者在进行配对分析后可进行比较。LIA组的疼痛评分明显更好（活动疼痛P = 0.019，最大疼痛P = 0.043，最小疼痛P < 0.001），但疼痛管理满意度并不更高（P = 0.083）。LIA组患者在恢复室所需的阿片类药物较少（P = 0.048），而非阿片类药物无显著差异（P = 0.603）。术后24小时在病房，非阿片类药物的使用无显著差异（P = 0.789），而LIA组患者接受的阿片类药物明显更多（P < 0.001）。尽管LIA在疼痛评分结果方面有所改善，且术后即刻患者满意度相当，但目前文献中存在争议的膝关节置换术中LIA的使用在本研究中未能减少阿片类止痛药物的需求。
