Iseki Takuya, Tsukada Sachiyuki, Wakui Motohiro, Kurosaka Kenji, Yoshiya Shinichi
Department of Orthopaedic Surgery, Nekoyama Miyao Hospital, 14-7 Konan, Chuo-ku, Niigata, Niigata, 950-1151, Japan.
Department of Orthopaedic Surgery, Hyogo College of Medicine, 1-1 Mukogawa-cho, Nishinomiya City, Hyogo, 663-8501, Japan.
BMC Musculoskelet Disord. 2019 Feb 8;20(1):61. doi: 10.1186/s12891-019-2451-1.
Although intraoperative periarticular multi-drug injection has been used for postoperative pain control after total knee arthroplasty (TKA), the injection has the inherent shortcoming of limited acting time. This randomized controlled trial was performed to assess whether adding percutaneous periarticular multi-drug injection at the day following TKA would improve the postoperative pain relief.
A total of 43 participants were randomly assigned to receive additional periarticular injection at 08:30, postoperative day 1 or no additional injection. The multi-drug solution including 40 mg of methylprednisolone, 150 mg of ropivacaine, and 0.1 mg of epinephrine was infiltrated into the muscle belly of the vastus medialis. In both groups, patients were treated with intraoperative periarticular multi-drug injection and postoperative intravenous and oral nonsteroidal anti-inflammatory drugs. We did not use any narcotic pain medications postoperatively. The primary outcome was the patients' global assessment of postoperative pain at rest measured using a visual analog scale (VAS) and quantified as the area under the curve (AUC) of serial assessments until 20:00, postoperative day 5.
The mean AUC for the postoperative pain VAS at rest was 1616 ± 1191 in patients received the additional periarticular injection versus 2808 ± 1494 in those received no injection (mean difference, - 1192; 95% confidence interval, - 2043 to - 340; p = 0.007). No wound complication or surgical site infection was observed in either groups.
Adding percutaneous periarticular multi-drug injection at the day following TKA may provide better postoperative pain relief. Further studies are needed to confirm the safety of the percutaneous injection.
University Hospital Medical Information Network UMIN000029003 . Registered 5 September 2017.
尽管术中关节周围多药注射已用于全膝关节置换术（TKA）后的术后疼痛控制，但该注射存在作用时间有限的固有缺点。本随机对照试验旨在评估在TKA术后第1天加用经皮关节周围多药注射是否能改善术后疼痛缓解情况。
共43名参与者被随机分配在术后第1天08:30接受额外的关节周围注射或不接受额外注射。将包含40mg甲泼尼龙、150mg罗哌卡因和0.1mg肾上腺素的多药溶液注入股内侧肌肌腹。两组患者均接受术中关节周围多药注射以及术后静脉和口服非甾体抗炎药治疗。术后未使用任何麻醉性止痛药物。主要结局是使用视觉模拟量表（VAS）测量患者静息时术后疼痛的总体评估，并量化为直至术后第5天20:00的系列评估曲线下面积（AUC）。
接受额外关节周围注射的患者静息时术后疼痛VAS的平均AUC为1616±1191，而未接受注射的患者为2808±1494（平均差值为-1192；95%置信区间为-2043至-340；p=0.007）。两组均未观察到伤口并发症或手术部位感染。
TKA术后第1天加用经皮关节周围多药注射可能会提供更好的术后疼痛缓解。需要进一步研究以确认经皮注射的安全性。
大学医院医学信息网络UMIN000029003。2017年9月5日注册。
