静脉注射和口服酮咯酸的阿片类药物节省疼痛方案可降低关节镜半月板手术后的阿片类药物消耗量和疼痛水平：一项前瞻性随机对照试验。
An Opioid-Sparing Pain Protocol of Intravenous and Oral Ketorolac Reduces Opioid Consumption and Pain Levels After Arthroscopic Meniscus Surgery: A Prospective, Randomized Controlled Trial.
作者信息
Strony John T, Mengers Sunita, Sivasundaram Lakshmanan, Sinkler Margaret, Wu Qian, Zhao Chenya, Sattar Abdus, Salata Michael J, Voos James E, Karns Michael R
机构信息
Department of Orthopaedic Surgery, University Hospitals Cleveland Medical Center, Cleveland, Ohio, U.S.A..
Department of Orthopaedic Surgery, University Hospitals Cleveland Medical Center, Cleveland, Ohio, U.S.A.
出版信息
Arthroscopy. 2025 Jun;41(6):1989-2001.e1. doi: 10.1016/j.arthro.2024.08.035. Epub 2024 Sep 5.
PURPOSE
To compare ketorolac to oxycodone-acetaminophen with respect to pain and opioid consumption after arthroscopic meniscus surgery. The secondary purpose was to compare short-term functional outcomes between the 2 protocols.
METHODS
A power analysis demonstrated that 43 patients were required. In this randomized control trial, patients with meniscal pathology undergoing arthroscopic meniscus surgery were included. Group 1 received oxycodone-acetaminophen alone. Group 2 received 1 dose of intravenous ketorolac intraoperatively, oral ketorolac upon discharge, and "rescue" oxycodone-acetaminophen. Patients recorded the number of opioid tablets consumed and visual analog pain scale (VAS) scores 3 times per day for 5 days postoperatively. Opioids were converted to morphine milligram equivalents (MMEs). VAS, Lysholm Knee Scoring Scale, and Knee injury and Osteoarthritis Outcome Score were obtained.
RESULTS
Forty-eight patients were randomized. There were 25 patients in the control group and 23 patients in the ketorolac group. The mean (SD) age was 47.9 (14.3) years. Fifty-two percent (n = 25) of the population were female. Three patients (6.3%) underwent meniscal repair. During the first 5 days postoperatively, the mean VAS score (β = -13.2, SE = 5.97, P = .029) and the MMEs consumed were significantly lower (β = -4.7, SE = 1.93, P = .015) per time point in the ketorolac group relative to the control group. The control group had better Lysholm Knee Scoring Scale (mean [SD] 80.6 [18.5] vs 65 [21.5], P = .016) and Knee injury and Osteoarthritis Outcome Score (mean [SD], 74.1 [16.7] vs 61.9 [18.6], P = .029) scores at 6 weeks. There were no significant differences in the rates of side effects.
CONCLUSIONS
An opioid-sparing pain protocol of intravenous and oral ketorolac is associated with significant reductions in VAS scores and MME consumption in the first 5 days after arthroscopic meniscus surgery. There were significant differences in patient-reported outcomes at final follow-up, favoring the control group. There were no significant differences in adverse reactions and side effects.
LEVEL OF EVIDENCE
Level II, prospective randomized controlled trial.
目的
比较酮咯酸与羟考酮-对乙酰氨基酚在关节镜半月板手术后的疼痛程度及阿片类药物使用量。次要目的是比较两种方案的短期功能结局。
方法
一项功效分析表明需要43例患者。在这项随机对照试验中，纳入了接受关节镜半月板手术的半月板病变患者。第1组仅接受羟考酮-对乙酰氨基酚。第2组术中接受1剂静脉注射酮咯酸，出院时接受口服酮咯酸以及“解救”用的羟考酮-对乙酰氨基酚。患者术后5天每天记录3次阿片类药物片剂服用数量及视觉模拟疼痛量表（VAS）评分。阿片类药物转换为吗啡毫克当量（MME）。获取VAS、Lysholm膝关节评分量表以及膝关节损伤与骨关节炎疗效评分。
结果
48例患者被随机分组。对照组25例患者，酮咯酸组23例患者。平均（标准差）年龄为47.9（14.3）岁。52%（n = 25）的人群为女性。3例患者（6.3%）接受了半月板修复。术后前5天，酮咯酸组相对于对照组，每个时间点的平均VAS评分（β = -13.2，标准误 = 5.97，P = .029）及MME消耗量显著更低（β = -4.7，标准误 = 1.93，P = .015）。对照组在6周时的Lysholm膝关节评分量表（平均[标准差]80.6[18.5]对65[21.5]，P = .016）及膝关节损伤与骨关节炎疗效评分（平均[标准差]74.1[16.7]对61.9[18.6]，P = .029）得分更高。副作用发生率无显著差异。
结论
关节镜半月板手术后前5天，静脉注射及口服酮咯酸的阿片类药物节省型镇痛方案与VAS评分及MME消耗量显著降低相关。最终随访时患者报告的结局存在显著差异，对照组更优。不良反应和副作用无显著差异。
证据级别
II级，前瞻性随机对照试验。
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