Department of Orthopedics, Qilu Hospital of Shandong University, Jinan, China.
Shandong University Cheeloo College of Medicine, Jinan, China.
Orthop Surg. 2024 Apr;16(4):873-881. doi: 10.1111/os.14018. Epub 2024 Feb 21.
Despite the use of multimodal analgesia, patients undergoing knee arthroplasty still encounter residual moderate pain. The addition of betamethasone to local anesthetic has been shown to improve postoperative pain. However, it remains uncertain whether the positive effects of perineural or intravenous administration of betamethasone on analgesia outcomes lead to better early mobility and postoperative recovery.
Between June 2022 and February 2023, a total of 159 patients who were undergoing knee arthroplasty were included in this study. These patients were allocated randomly into three groups: (i) the NS group, received ropivacaine 0.375% and intravenous 3mL 0.9% normal saline; (ii) the PNB group, received ropivacaine 0.375% plus perineural betamethasone (12mg) 3mL and intravenous 3mL 0.9% normal saline; and (iii) the IVB group, received ropivacaine 0.375% and intravenous betamethasone (12mg) 3mL.
Both perineural and intravenous administration of betamethasone led to improved median (IQR) numeric rating scale (NRS) scores on the 6-meter walk test, with a score of 1.0 (1.0-2.0) for both groups, compared with 2.0 (1.0-2.0) for the NS group (p = 0.003). Compared to the NS group, both the PNB and IVB groups showed significant reductions in NRS scores at 24 and 36 h after surgery, along with a significant increase in ROM at 24, 36, and 48 h post-operation. Additionally, it exhibited lower levels of cytokine IL-1β and TNF-α in fluid samples, as well as lower level of HS-CRP in blood samples in the PNB and IVB groups compared to the NS group.
The administration of perineural and intravenous betamethasone demonstrated an enhanced analgesic effect following knee arthroplasty. Furthermore, it was associated with reduced levels of IL-1β, TNF-α, and HS-CRP, as well as enhanced knee ROM, which is conducive to early ambulation and postoperative rehabilitation after knee arthroplasty.
尽管采用了多模式镇痛，但接受膝关节置换术的患者仍会出现残余的中度疼痛。向局部麻醉剂中加入倍他米松已被证明可以改善术后疼痛。然而，尚不确定神经周围或静脉内给予倍他米松对镇痛结果的积极影响是否会导致更好的早期活动能力和术后恢复。
2022 年 6 月至 2023 年 2 月，共纳入 159 名接受膝关节置换术的患者。这些患者被随机分为三组：（i）NS 组，接受罗哌卡因 0.375%和静脉内 3mL 0.9%生理盐水；（ii）PNB 组，接受罗哌卡因 0.375%加周围神经内倍他米松（12mg）3mL 和静脉内 3mL 0.9%生理盐水；和（iii）IVB 组，接受罗哌卡因 0.375%和静脉内倍他米松（12mg）3mL。
周围神经内和静脉内给予倍他米松均导致 6 米步行测试的中位数（IQR）数字评定量表（NRS）评分改善，两组评分为 1.0（1.0-2.0），而 NS 组评分为 2.0（1.0-2.0）（p=0.003）。与 NS 组相比，PNB 组和 IVB 组在手术后 24 和 36 小时的 NRS 评分均显著降低，并且在术后 24、36 和 48 小时时 ROM 显著增加。此外，与 NS 组相比，PNB 组和 IVB 组的液样本中的细胞因子 IL-1β 和 TNF-α水平以及血样本中的 HS-CRP 水平均较低。
膝关节置换术后，周围神经内和静脉内给予倍他米松可增强镇痛效果。此外，它与降低 IL-1β、TNF-α 和 HS-CRP 水平以及增强膝关节 ROM 相关，这有助于膝关节置换术后的早期活动和术后康复。
