Department of Orthopedics, Chengdu Second People's Hospital, Chengdu, People's Republic of China.
Department of Orthopedics, West China Hospital/West China School of Medicine, Sichuan University, 37# Wuhou Guoxue Road, Chengdu, 610041, People's Republic of China.
J Orthop Surg Res. 2021 Jan 22;16(1):81. doi: 10.1186/s13018-020-02182-8.
The aim of this study was to evaluate the efficacy of local infiltration anaesthesia (LIA) during primary total hip arthroplasty (THA) via a posterolateral approach under general anaesthesia and to compare the efficacy of LIA in all layers with LIA in the deep and superficial fascia.
One hundred twenty patients were randomised into three groups: LIA in the deep and superficial fascia (group A), LIA in all layers (group B) and the control (group C). The primary outcomes were the visual analogue scale (VAS) pain scores at rest and on movement within 72 h (h) postoperatively. The secondary outcomes included opioid consumption, patient satisfaction, range of motion (ROM), straight leg raise completion rate, length of hospital stay, opioid-related side effects and wound complications. We followed the patients until 6 months after discharge.
At 2 and 6 h, groups A and B had lower resting VAS scores than group C (p < 0.01); at 12 h, group B had a lower resting VAS score than group C (p < 0.05). At 6 and 12 h, the movement VAS scores in groups A and B were lower than those in group C (p < 0.01). Groups A and B had similar VAS scores during the observation period. Groups A and B had higher levels of patient satisfaction than group C (p = 0.03 and p = 0.018, respectively). Opioid consumption was similar in the three groups. There were no significant differences in the other secondary outcomes amongst the three groups. No difference was found in hip rehabilitation or chronic pain during the follow-up period.
Single-shot LIA with ropivacaine alone reduces the pain score during the first 12 postoperative hours and improves patients' satisfaction with THA. LIA in the deep and superficial fascia and LIA in all layers have similar analgesic effects. LIA in the deep and superficial fascia may be an alternative method to LIA in all layers.
本研究旨在评估全身麻醉下经后外侧入路行初次全髋关节置换术（THA）时行局部浸润麻醉（LIA）的疗效，并比较深层和浅层筋膜的 LIA 与全层 LIA 的疗效。
120 例患者随机分为三组：深层和浅层筋膜中的 LIA（A 组）、全层 LIA（B 组）和对照组（C 组）。主要观察指标为术后 72 小时内静息和运动时的视觉模拟评分（VAS）疼痛评分。次要观察指标包括阿片类药物用量、患者满意度、活动度（ROM）、直腿抬高完成率、住院时间、阿片类药物相关副作用和伤口并发症。我们随访患者直到出院后 6 个月。
术后 2 小时和 6 小时时，A 组和 B 组的静息 VAS 评分均低于 C 组（p < 0.01）；术后 12 小时时，B 组的静息 VAS 评分低于 C 组（p < 0.05）。术后 6 小时和 12 小时时，A 组和 B 组的运动 VAS 评分均低于 C 组（p < 0.01）。观察期间，A 组和 B 组的 VAS 评分相似。A 组和 B 组的患者满意度均高于 C 组（p = 0.03 和 p = 0.018）。三组阿片类药物用量无显著差异。三组间其他次要观察指标无显著差异。随访期间，髋关节康复或慢性疼痛无差异。
单次罗哌卡因 LIA 可降低术后前 12 小时的疼痛评分，提高患者对 THA 的满意度。深层和浅层筋膜中的 LIA 与全层 LIA 具有相似的镇痛效果。深层和浅层筋膜中的 LIA 可能是全层 LIA 的替代方法。
