CritiCare Multispecialty Hospital, Mumbai, Maharashtra, India.
J Arthroplasty. 2020 Jun;35(6S):S178-S181. doi: 10.1016/j.arth.2020.02.015. Epub 2020 Feb 13.
Total knee arthroplasty (TKA) is associated with moderate-to-severe postoperative pain. Satisfactory perioperative analgesia is essential for a good and predictable surgical outcome. Effective postoperative pain control is a major challenge to the treating surgeon and his team. Old age and multiple comorbidities restrict the choice of analgesics one can offer. Transdermal buprenorphine (TDB), widely used in chronic pain management, has been rarely studied in acute postoperative setting. The purpose of this study was to compare the safety and efficacy of a TDB patch to conventional analgesics after knee arthroplasty surgery.
A prospective randomized study was conducted with 200 patients aged 60-75 years undergoing TKA surgery under neuraxial anesthesia. All patients received periarticular local anesthetic infiltration and epidural/femoral nerve block infusion for 72 hours postoperatively. Group A received the TDB patch 5 mcg applied at the end of surgery. Group B received a combination of paracetamol and tramadol. All patients received intravenous diclofenac as rescue analgesia. Pain scores at rest, on movement, and side effects, if any, were compared over 7 days using the numerical rating scale score.
Pain scores at rest and on movement were significantly lower in group A (P values .008 and .01). Rescue analgesia requirement was also significantly less in this group. Only one patient had clinically significant respiratory depression, and 3 patients had local erythema.
Our data shows that the TDB patch is more efficacious in reducing postoperative pain after TKA surgery and can be safely used with fewer systemic side effects when compared to conventional analgesics.
全膝关节置换术（TKA）术后伴有中重度疼痛。满意的围手术期镇痛对于良好且可预测的手术结果至关重要。有效的术后疼痛控制是治疗医生及其团队面临的主要挑战。老年和多种合并症限制了可供选择的镇痛药物。透皮丁丙诺啡（TDB）广泛应用于慢性疼痛管理，在急性术后环境中很少研究。本研究旨在比较 TDB 贴剂与膝关节置换术后常规镇痛剂的安全性和疗效。
对 200 名年龄在 60-75 岁之间接受椎管内麻醉下 TKA 手术的患者进行前瞻性随机研究。所有患者在术后 72 小时内接受关节周围局部麻醉浸润和硬膜外/股神经阻滞输注。A 组在手术结束时给予 TDB 贴剂 5 mcg。B 组给予对乙酰氨基酚和曲马多联合治疗。所有患者均接受静脉注射双氯芬酸作为解救性镇痛。使用数字评分量表在 7 天内比较静息时、运动时的疼痛评分和任何副作用。
A 组静息和运动时的疼痛评分显著较低（P 值分别为.008 和.01）。该组的解救性镇痛需求也显著减少。只有 1 例患者出现临床显著的呼吸抑制，3 例患者出现局部红斑。
与传统镇痛剂相比，TDB 贴剂在 TKA 手术后减轻术后疼痛更有效，且全身副作用更少。
