Tyler Andrew F, Ahn Jaimo, Donegan Derek J
Orthopaedic Surgery, Hospital Corporation of America (HCA) Houston Healthcare Clear Lake, Webster, USA.
Orthopaedic Surgery, University of Michigan, Ann Arbor, USA.
Cureus. 2022 Mar 28;14(3):e23569. doi: 10.7759/cureus.23569. eCollection 2022 Mar.
The opioid epidemic in the United States has forced care providers to seek out alternatives to narcotic analgesics. Physicians involved in trauma care, including orthopaedic trauma surgeons, often have patients requiring significant amounts of these medications, especially in the perioperative period, given the acuity and severity of their injuries. Modalities such as local infiltration of fractures with anesthetic agents during operative treatment may provide some benefit to this population by decreasing postoperative pain and narcotic usage. However, prior data suggest that these agents are chondrotoxic, which may impede secondary fracture healing. The purpose of this study was to investigate the hypothesis that local anesthetics decrease secondary bone healing and callus formation in stabilized murine femur fractures through chondrocyte apoptosis. Male C57BL/6 mice underwent intramedullary stabilization and fracture of bilateral femurs followed by immediate infiltration of the fracture site with local anesthetic agents. Femurs were dissected at 10- and 20-days post-fracture and evaluated by [Formula: see text]CT and histological analysis. No significant differences were seen in callus size or mineralization between controls and fractures treated with a local anesthetic. When the callus was analyzed histologically, local anesthetic agents appeared to increase cartilage density. Therefore, infiltration of local anesthetics during operative treatment of fracture as part of a multimodal approach to pain control does not appear to significantly affect callus formation in a preclinical model, although subclinical molecular effects may be present. Local infiltrative analgesia with local anesthetics may be used as an adjunct for perioperative pain control during femur fracture surgery without a significant effect on secondary bone healing.
美国的阿片类药物泛滥迫使医疗服务提供者寻找麻醉性镇痛药的替代品。参与创伤护理的医生，包括骨科创伤外科医生，经常会遇到需要大量此类药物的患者，尤其是在围手术期，因为他们的伤势严重且危急。在手术治疗期间，用麻醉剂对骨折部位进行局部浸润等方式，可能通过减轻术后疼痛和减少麻醉药物使用，对这类患者有一定益处。然而，既往数据表明这些药物具有软骨毒性，这可能会阻碍骨折的二期愈合。本研究的目的是探讨局部麻醉药通过软骨细胞凋亡减少稳定的小鼠股骨骨折二期骨愈合和骨痂形成这一假说。雄性C57BL/6小鼠接受双侧股骨的髓内固定和骨折，随后立即用局部麻醉药浸润骨折部位。在骨折后10天和20天解剖股骨，并通过[公式：见正文]CT和组织学分析进行评估。在对照组和用局部麻醉药治疗的骨折组之间，骨痂大小或矿化程度未见显著差异。对骨痂进行组织学分析时，局部麻醉药似乎增加了软骨密度。因此，在骨折手术治疗期间，作为多模式疼痛控制方法的一部分使用局部麻醉药浸润，在临床前模型中似乎不会显著影响骨痂形成，尽管可能存在亚临床分子效应。局部麻醉药局部浸润镇痛可作为股骨骨折手术围手术期疼痛控制的辅助手段，而对二期骨愈合无显著影响。
