Department of Orthopedics, West China Hospital/West China School of Medicine, Sichuan University, Chengdu, China.
Orthop Surg. 2022 Aug;14(8):1799-1807. doi: 10.1111/os.13288. Epub 2022 Jul 13.
This study aimed to observe the analgesic effect of the cocktail formulation with diprospan during total hip arthroplasty (THA).
From September 2018 to April 2019, 120 patients undergoing primary unilateral THA were included in this prospective, randomized, observer-blinded study. Patients were randomized into three groups, according to the different local infiltration analgesia (LIA) strategies: LIA with ropivacaine (the ropivacaine group, n = 40), LIA with a new cocktail containing ropivacaine, diprospan, and morphine (the cocktail group, n = 40), and the control group (n = 40). The primary outcomes included postoperative pain scores. The resting visual analogue scale (VAS) scores were measured at 2, 6, and 12 h after the surgery (a.m. and p.m.) on postoperative day (POD) 1, POD2, and the day of discharge. Movement VAS scores were assessed at 6 h, 12 h after the operation (a.m. and p.m.) on POD1, POD2, and the day of discharge. The secondary outcomes included opioid consumption, postoperative hospital stay, range of motion of the hip at discharge, patient satisfaction, and the results of the follow-up.
After the screening, 120 patients were randomized into three groups (40 patients in each group). All of the patients completed the trial. The resting VAS scores in the ropivacaine group and cocktail group at 2 h were lower than those in the control group (P < 0.001 and P < 0.001, respectively, F = 17.054), and the same trend was also postoperatively found at 6 h (p = 0.005 and P = 0.002, F = 6.212). Twelve hours after the operation, the pain score in the cocktail group was lower than that in the other two groups, but only the difference between the cocktail group and the control group was statistically significant (P = 0.018, F = 3.144). From the morning of the first postoperative day to the a.m. on POD 2, the VAS scores in the cocktail group were significantly lower than those in the ropivacaine group and the control group. Furthermore, the movement VAS scores in the ropivacaine group and the cocktail group were better than those in the control group at 6 and 12 h post-operation (P < 0.05). The per capita opioid consumption in the cocktail group was less than that in the ropivacaine group and the control group within 24 h post-operation. There were no significant differences in the comparison of additional indicators among the three groups.
The new cocktail with diprospan had a better result and longer duration time for early postoperative pain control in primary THA via the posterolateral approach under general anesthesia, especially for treating resting pain.
本研究旨在观察曲安奈德鸡尾酒配方在全髋关节置换术（THA）中的镇痛效果。
本前瞻性、随机、观察者盲法研究纳入了 2018 年 9 月至 2019 年 4 月期间接受初次单侧 THA 的 120 例患者。患者根据不同的局部浸润镇痛（LIA）策略随机分为三组：罗哌卡因 LIA 组（n=40）、含罗哌卡因、曲安奈德和吗啡的新鸡尾酒 LIA 组（n=40）和对照组（n=40）。主要结局包括术后疼痛评分。术后第 1 天（术后第 1 天）、第 2 天（术后第 2 天）和出院当天（上午和下午）测量静息视觉模拟评分（VAS），术后第 2 天、第 2 天和出院当天测量运动 VAS 评分（上午和下午）。次要结局包括阿片类药物消耗量、术后住院时间、出院时髋关节活动范围、患者满意度和随访结果。
经过筛选，120 例患者随机分为三组（每组 40 例）。所有患者均完成了试验。罗哌卡因组和鸡尾酒组术后 2 小时静息 VAS 评分低于对照组（P<0.001 和 P<0.001，F=17.054），术后 6 小时也有同样趋势（p=0.005 和 P=0.002，F=6.212）。术后 12 小时，鸡尾酒组疼痛评分低于其他两组，但仅与对照组比较差异有统计学意义（P=0.018，F=3.144）。从术后第 1 天上午到术后第 2 天上午，鸡尾酒组 VAS 评分明显低于罗哌卡因组和对照组。此外，术后 6 小时和 12 小时，罗哌卡因组和鸡尾酒组的运动 VAS 评分均优于对照组（P<0.05）。术后 24 小时内，鸡尾酒组人均阿片类药物消耗量低于罗哌卡因组和对照组。三组间其他指标比较差异无统计学意义。
曲安奈德鸡尾酒在全身麻醉下经后外侧入路行初次 THA 时，对早期术后疼痛控制具有更好的效果和更长的作用时间，特别是在治疗静息痛方面。
