全膝关节置换术后右美托咪定与酮咯酸作为罗哌卡因添加剂的关节周围浸润比较研究：一项前瞻性、随机双盲研究

A Comparative Study of Periarticular Infiltration with Dexmedetomidine versus Ketorolac as an Additive to Ropivacaine after Total Knee Arthroplasty: A Prospective, Randomized Double-Blind Study.

作者信息

Nikhar Sapna Annaji, Yadav Monu, Damera Shashi, Mohan Lalith, Ch V Jyotsna, Ramachandran Gopinath

机构信息

Department of Anaesthesiology and Intensive Care, Nizam's Institute of Medical Sciences, Hyderabad, Telangana, India.

Department of Orthopedics, Nizam's Institute of Medical Sciences, Hyderabad, Telangana, India.

出版信息

Anesth Essays Res. 2020 Oct-Dec;14(4):550-554. doi: 10.4103/aer.AER_18_21. Epub 2021 May 27.

DOI:10.4103/aer.AER_18_21

PMID:34349318

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC8294412/

Abstract

BACKGROUND

Periarticular infiltration (PAI) analgesia has been found to be an effective analgesia modality after total knee arthroplasty (TKA). Dexmedetomidine has many beneficial effects on postoperative analgesia by different routes, but studies on PAI are lagging.

AIMS AND OBJECTIVES

In this study, we compared postoperative analgesia after PAI with dexmedetomidine versus ketorolac as an additive to ropivacaine after TKA.

SETTING AND DESIGN

This is a prospective, randomized, double-blind study conducted on 75 patients belonging to American Society of Anesthesiologists I to III, undergoing total knee arthroplasty, of either gender, belonging to American Society of Anesthesiologists I to III.

MATERIALS AND METHODS

After institutional ethics committee approval and written informed consent, patients were randomly allocated into three groups. Group C ( = 25) received cocktail of 60 mL ropivacaine (0.25%) infiltration with adrenaline 5 mL (0.1 mg.mL), Group D ( = 25) received additive dexmedetomidine 1 ug.kg to above cocktail, and Group K ( = 25) received ketorolac 30 mg. Postoperatively pain by Visual Analog Scale, vitals, total duration of analgesia, need for rescue analgesia, sedation, patient satisfaction, mobilization time, and complications were recorded.

STATISTICAL ANALYSIS

The Statistical Package for the Social Sciences version 20 was used for statistical analysis. Analysis of variance has been used to find the significance of study parameters between the three groups of patients. < 0.05 was considered statistically significant.

RESULTS

Postoperative pain score was lesser in the ketorolac group (1.52 ± 0.71, = 0.001) than the other two groups. Duration of analgesia was more with ketorolac (343.00 ± 144.45, < 0.001) compared with the other two groups, and epidural activation timings (462 ± 235.84) were significantly delayed in Group K compared to Group C and Group D. There was no significant difference in mobilization time, patient satisfaction, and complications between the three groups.

CONCLUSION

Ketorolac was a better additive to ropivacaine than dexmedetomidine for postoperative analgesia after TKA.

摘要

背景

关节周围浸润（PAI）镇痛已被发现是全膝关节置换术（TKA）后一种有效的镇痛方式。右美托咪定通过不同途径对术后镇痛有许多有益作用，但关于PAI的研究滞后。

目的

在本研究中，我们比较了TKA后PAI联合右美托咪定与酮咯酸作为罗哌卡因添加剂的术后镇痛效果。

设置与设计

这是一项前瞻性、随机、双盲研究，对75例美国麻醉医师协会I至III级、接受全膝关节置换术的患者进行，患者性别不限，属于美国麻醉医师协会I至III级。

材料与方法

经机构伦理委员会批准并获得书面知情同意后，将患者随机分为三组。C组（n = 25）接受60 mL罗哌卡因（0.25%）与5 mL肾上腺素（0.1 mg/mL）的混合液浸润，D组（n = 25）在上述混合液中加入右美托咪定1 μg/kg，K组（n = 25）接受酮咯酸30 mg。记录术后视觉模拟评分法疼痛程度、生命体征、镇痛总时长、补救镇痛需求、镇静情况、患者满意度、活动时间及并发症。

统计分析

使用社会科学统计软件包第20版进行统计分析。采用方差分析来确定三组患者研究参数的显著性。P < 0.05被认为具有统计学显著性。

结果

酮咯酸组术后疼痛评分低于其他两组（1.52 ± 0.71，P = 0.001）。与其他两组相比，酮咯酸组的镇痛时长更长（343.00 ± 144.45，P < 0.001），且K组的硬膜外激活时间（462 ± 235.84）相较于C组和D组显著延迟。三组之间的活动时间、患者满意度及并发症无显著差异。