全膝关节置换术后的疼痛管理：一项前瞻性随机研究。
Pain management after total knee arthroplasty: A prospective randomized study.
作者信息
Paglia A, Goderecci R, Ciprietti N, Lagorio M, Necozione S, Calvisi V
机构信息
Department of Life, Health and Environmental Sciences, University of L'Aquila, Via Vetoio, Coppito 2, 67100, L'Aquila, Italy.
UOSD, Department of Mini-invasive and Computer-assisting Orthopaedic Surgery, San Salvatore Hospital, Via L. Natali 1, 67100, L'aquila, Italy.
出版信息
J Clin Orthop Trauma. 2020 Jan-Feb;11(1):113-117. doi: 10.1016/j.jcot.2018.12.005. Epub 2018 Dec 14.
INTRODUCTION
Total knee arthroplasty (TKA) is a common procedure for improving mobility and quality of life in patients with osteoarthritis. Postoperative pain control management after TKA is still a concern as it relates to patients satisfaction and functional recovery.Many anesthetic regimens and techniques have been explored to decrease postoperative pain and enhance the fast recovery after TKA. The aim of this study was to evaluate the best anesthetic treatment in pain control after TKA.
METHODS
51 patients were included in a randomized prospective study and distributed in three groups. The first group (CG) in which no analgesic protocol was implemented (control group). The second group (LIA group) received an intraoperative local infiltration anesthesia (LIA) (60 ml mixture of two ropivacaine 75mg/10 mL + adrenaline 100μg/10 mL + physiological solution). The third group (FNB group) had only a femoral nerve block (FNB). Continuous outcomes including visual analogue scale (VAS) at 5,24,48 h and at 1 week, morphine consumption and range of motion (ROM) at 1,2,7 days.
RESULTS
There was significant difference between all groups (p < 0,001) in terms of the VAS score: at 5h after surgery (4.55,2.15,1.82); at 24h (4.15,2.65,3.36); at 48h (3.85,2.45,2.73); at 1 week (2.95,1.80, 1.64), respectively for groups CG, LIA, FNB.ROM was better in LIA and FNB groups than CG: at 1 die after surgery (44°,50°,54°); at 3 dies (69°,70°,71°); at 7 dies (91°,98°,98°), respectively for groups CG, LIA, FNB (p < 0,001).
DISCUSSION
LIA and FNB groups both showed a significant reduction at VAS score, better range of motion and less morphine consumption than CG (control group). LIA group has obtained a constant pain control in the postoperative days; FNB group had a good pain control in the hours after surgery, with a decrease in efficacy in the following days.
CONCLUSION
Further studies are still needed in order to define LIA as the reference pain management in TKA.
引言
全膝关节置换术（TKA）是改善骨关节炎患者活动能力和生活质量的常见手术。TKA术后的疼痛控制管理仍是一个关注点，因为它与患者满意度和功能恢复相关。人们已经探索了许多麻醉方案和技术来减轻TKA术后疼痛并促进快速恢复。本研究的目的是评估TKA术后疼痛控制的最佳麻醉治疗方法。
方法
51例患者纳入一项随机前瞻性研究，并分为三组。第一组（CG组）未实施任何镇痛方案（对照组）。第二组（LIA组）接受术中局部浸润麻醉（LIA）（60毫升由两种罗哌卡因75毫克/10毫升+肾上腺素100微克/10毫升+生理盐水组成的混合液）。第三组（FNB组）仅进行股神经阻滞（FNB）。连续观察指标包括术后5、24、48小时及1周时的视觉模拟评分（VAS）、吗啡用量以及术后1、2、7天的关节活动范围（ROM）。
结果
在VAS评分方面，所有组之间均存在显著差异（p<0.001）：术后5小时（4.55、2.15、1.82）；术后24小时（4.15、2.65、3.36）；术后48小时（3.85、2.45、2.73）；术后1周（2.95、1.80、1.64），分别对应CG组、LIA组、FNB组。LIA组和FNB组的ROM优于CG组：术后1天（44°、50°、54°）；术后3天（69°、70°、71°）；术后7天（91°、98°、98°），分别对应CG组、LIA组、FNB组（p<0.001）。
讨论
LIA组和FNB组在VAS评分上均显著降低，关节活动范围更好，吗啡用量比CG组（对照组）少。LIA组在术后几天内实现了持续的疼痛控制；FNB组在术后数小时内疼痛控制良好，但在随后几天效果有所下降。
结论
为了将LIA确定为TKA中参考的疼痛管理方法，仍需要进一步研究。
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