Xu Jianda, Qu Yuxing, Li Huan, Jiang Tao, Zheng Chong, Wang Bin, Shen Pengfei
Department of Orthopaedics, Changzhou Traditional Chinese Medical Hospital, Changzhou, Jiangsu 213003, China,
Department of Arthroplasty, The First People's Hospital of Changzhou, Changzhou, Jiangsu 213003, China,
J Pain Res. 2019 Jan 17;12:417-422. doi: 10.2147/JPR.S178413. eCollection 2019.
To date, a regional approach using local anesthetics has become a popular analgesic method for arthroscopy. The optimal postoperative analgesia method for shoulder arthroscopy is still debated.
This study was designed to evaluate the effect and safety of using ketorolac in combination with a multimodal drug regime (ropivacaine, morphine, and triamcinolone acetonide) after shoulder arthroscopy.
A total of 60 patients were included in a pilot study and patients were randomized into an experimental group (n=30) and a control group (n=30). The following parameters were used to evaluate pain relief levels postoperatively: the Visual Analog Scale (VAS) at 1, 3, 6, 12, 24, and 48 hours postoperatively, morphine consumption, and initial analgesic desired time. Complications were also recorded.
Except for 1 hour postoperatively, patients in the experimental group experienced lower VAS scores during the first 48 hours postoperatively (<0.05). The VAS score in both groups increased after 3 hours postoperatively and peaked at 12 hours postoperatively (2.54±0.86 vs 3.25±1.18). The VAS scores on movement in the experimental group were lower than those in the control group at 24 or 48 hours postoperatively (=0.004, 0.001). A total of 18 (60.0%) patients in the experimental group required no additional analgesia, compared with 10 (33.3 %) in the control group (=0.035). The mean rescue analgesia was 11.40±5.56 mg in the experiment group, while 16.57±8.48 mg in the control group (=0.016). The initial analgesic desired time was delayed significantly in the experimental group (16.50±14.57 hours vs 8.9±6.32 hours, =0.000).
Adding ketorolac to intra-articular injection analgesia is a safe and effective method to improve pain relief after shoulder arthroscopy, and further prospective controlled trials are necessary to allow definite treatment recommendations.
迄今为止，使用局部麻醉剂的区域麻醉方法已成为关节镜检查常用的镇痛方法。肩关节镜检查术后的最佳镇痛方法仍存在争议。
本研究旨在评估酮咯酸联合多模式药物方案（罗哌卡因、吗啡和曲安奈德）用于肩关节镜检查术后的效果和安全性。
一项初步研究共纳入60例患者，将患者随机分为实验组（n = 30）和对照组（n = 30）。采用以下参数评估术后疼痛缓解程度：术后1、3、6、12、24和48小时的视觉模拟评分（VAS）、吗啡用量及首次需要镇痛的时间。同时记录并发症情况。
除术后1小时外，实验组患者在术后48小时内VAS评分较低（P<0.05）。两组术后3小时VAS评分均升高，并在术后12小时达到峰值（2.54±0.86 vs 3.25±1.18）。术后24或48小时，实验组运动时的VAS评分低于对照组（P = 0.004，0.001）。实验组共有18例（60.0%）患者无需额外镇痛，而对照组为10例（33.3%）（P = 0.035）。实验组平均补救性镇痛量为11.40±5.56 mg，而对照组为16.57±8.48 mg（P = 0.016）。实验组首次需要镇痛的时间显著延迟（16.50±14.57小时 vs 8.9±6.32小时，P = 0.000）。
在关节腔内注射镇痛中添加酮咯酸是改善肩关节镜检查术后疼痛缓解的一种安全有效的方法，需要进一步进行前瞻性对照试验以给出明确的治疗建议。
