Division of Perioperative Care, Department of Anesthesiology, Intensive Care and Pain Medicine, Jorvi Hospital, Helsinki University Hospital, University of Helsinki, Helsinki, Finland.
Division of Perioperative Care, Department of Anesthesiology, Intensive Care and Pain Medicine, Turku University Hospital, University of Turku, Turku, Finland.
Acta Anaesthesiol Scand. 2019 Nov;63(10):1406-1412. doi: 10.1111/aas.13440. Epub 2019 Jul 19.
Post-operative pain after an above-knee amputation is often severe, and in the elderly patients the adverse effects of post-operative opioids are evident. We hypothesized that continuous perineural local anesthetic infusion (CPI) combined to a wound infusion will reduce acute pain and opioid consumption compared to placebo after above knee amputation.
Ninety-three patients going through an above knee amputation were recruited for this randomized, controlled trial. Two catheters were placed, one to the sciatic nerve sheath and one under the fasciae during the amputation. After two 10 mL boluses of ropivacaine 0.75% a post-operative infusion of ropivacaine 0.2% or placebo (NaCl 0.9%) at 2 mL/h was administered for 72 hours to both catheters. The primary outcome was average stump pain during the first 5 days.
The mean intensity of stump pain during the first five post-operative days was 1.4 (0.8) in the CPI group and 1.9 (0.9) in the placebo group on VRS, mean (SD), P = .006. The opioid consumption on first five post-operative days did not differ between the groups.
A combination of continuous perineural and wound local anesthetic infusion seems to diminish the intensity of stump pain after above knee amputation.
膝上截肢术后的疼痛通常较为剧烈，老年患者术后阿片类药物的不良反应更为明显。我们假设与安慰剂相比，连续外周神经局部麻醉输注（CPI）联合伤口输注将减少膝上截肢后的急性疼痛和阿片类药物的消耗。
本随机对照试验共招募了 93 名接受膝上截肢的患者。在截肢过程中，将两根导管放置在坐骨神经鞘内和筋膜下。在两次给予罗哌卡因 0.75% 的 10ml 推注后，将罗哌卡因 0.2%（或安慰剂[NaCl 0.9%]）以 2ml/h 的速度输注到两个导管中，持续 72 小时。主要结局是术后 5 天内残端疼痛的平均强度。
在 VRS 上，CPI 组术后第 1 至 5 天残端疼痛的平均强度为 1.4（0.8），安慰剂组为 1.9（0.9），平均（SD），P=0.006。两组术后第 1 至 5 天的阿片类药物消耗量无差异。
连续外周神经和伤口局部麻醉输注的联合应用似乎可以减轻膝上截肢后的残端疼痛强度。
