关节腔内注射布比卡因脂质体停止输注对初次全膝关节置换术后疼痛管理无影响：对疼痛评分、阿片类药物消耗或功能状态无影响。
Discontinuation of the liposomal delivery of bupivacaine has no effect on pain management after primary total knee arthroplasty : no effect on pain scores, opioid consumption, or functional status.
机构信息
Division of Adult Reconstructive Surgery and Department of Orthopedic Surgery, NYU Langone Health, New York, New York, USA.
Department of Orthopaedic Surgery, Beaumont Health, Royal Oak, Michigan, USA.
出版信息
Bone Joint J. 2021 Jun;103-B(6 Supple A):102-107. doi: 10.1302/0301-620X.103B6.BJJ-2020-2033.R1.
AIMS
Liposomal bupivacaine (LB) as part of a periarticular injection protocol continues to be a highly debated topic in total knee arthroplasty (TKA). We evaluated the effect of discontinuing the use of LB in a periarticular protocol on immediate postoperative pain scores, opioid consumption, and objective functional outcomes.
METHODS
On 1 July 2019, we discontinued the use of intraoperative LB as part of a periarticular injection protocol. A consecutive group of patients who received LB as part of the protocol (Protocol 1) and a subsequent group who did not (Protocol 2) were compared. All patients received the same opioid-sparing protocol. Verbal rating scale (VRS) pain scores were collected from our electronic data warehouse and averaged per patient per 12-hour interval. Events relating to the opiate administration were derived as morphine milligram equivalences (MMEs) per patient per 24-hour interval. The Activity Measure for Post-Acute Care (AM-PAC) tool was used to assess the immediate postoperative function.
RESULTS
A total of 888 patients received Protocol 1 and while 789 received Protocol 2. The mean age of the patients was significantly higher in those who did not receive LB (66.80 vs 65.57 years, p = 0.006). The sex, BMI, American Society of Anesthesiologists physical status score, race, smoking status, marital status, operating time, length of stay, and discharge disposition were similar in the two groups. Compared with the LB group, discontinuing LB showed no significant difference in postoperative VRS pain scores up to 72 hours (p > 0.05), opioid administration up to 96 hours (p > 0.05), or AM-PAC scores within the first 24 hours (p > 0.05).
CONCLUSION
The control of pain after TKA with a multimodal management protocol is not improved by the addition of LB compared with traditional bupivacaine. Cite this article: 2021;103-B(6 Supple A):102-107.
目的
关节周注射中使用包载布比卡因的脂质体（LB）仍是全膝关节置换术（TKA）中极具争议的话题。我们评估了关节周注射方案中停止使用 LB 对术后即刻疼痛评分、阿片类药物使用量和客观功能结果的影响。
方法
2019 年 7 月 1 日，我们停止在关节周注射方案中使用 LB。我们比较了接受关节周注射方案中 LB（方案 1）和未接受（方案 2）的连续患者组。所有患者均接受相同的阿片类药物节约方案。从我们的电子数据仓库中收集口述评分量表（VRS）疼痛评分，并按每位患者每 12 小时间隔平均计算。根据每位患者每 24 小时间隔的吗啡毫克等效物（MME）得出与阿片类药物使用相关的事件。术后即刻功能使用术后急性护理活动量表（AM-PAC）工具进行评估。
结果
共有 888 例患者接受了方案 1，而 789 例患者接受了方案 2。未接受 LB 的患者年龄明显较大（66.80 岁 vs 65.57 岁，p = 0.006）。两组患者的性别、BMI、美国麻醉医师协会身体状况评分、种族、吸烟状况、婚姻状况、手术时间、住院时间和出院去向相似。与 LB 组相比，停止 LB 对术后 72 小时内的 VRS 疼痛评分（p > 0.05）、96 小时内的阿片类药物使用（p > 0.05）或 24 小时内的 AM-PAC 评分（p > 0.05）均无显著差异。
结论
与传统布比卡因相比，多模式管理方案在 TKA 后控制疼痛中加入 LB 并不能提高疼痛控制效果。
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