Department of Orthopaedics, Second Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, 310005, P.R. China.
J Orthop Surg Res. 2024 Nov 18;19(1):764. doi: 10.1186/s13018-024-05233-6.
Periarticular local infiltration analgesia (LIA) has become a widely used method for postoperative pain management after unicompartmental knee arthroplasty (UKA). However, the efficacy of using magnesium sulphate or sodium bicarbonate in LIA cocktails during UKA is not yet clear. The present study aimed to evaluate whether the modified LIA has advantages in pain control and joint function recovery after UKA surgery.
Sixty-one patients who underwent UKA were enrolled and randomly assigned to receive periarticular infiltration of a modified cocktail (comprising ropivacaine, epinephrine, dexamethasone, magnesium sulphate, and sodium bicarbonate) or a conventional cocktail (comprising ropivacaine, epinephrine, dexamethasone, ketorolac, and morphine). The outcomes included the consumption of patient-controlled intravenous analgesia (PCIA) medication used for postoperative analgesia, pain score, early joint functional recovery, discharge time, and complication rates.
In the first 12 h after surgery, the conventional cocktail was not superior to the modified cocktail in terms of visual analogue scale (VAS) scores. However, beginning on the second postoperative day, the analgesic effect was significantly prolonged in the modified group, leading to lower VAS scores and better knee functional recovery. Additionally, patients in the modified group required less pain medication via PCIA, both within the first 24 h and cumulatively up to 48 h after surgery. Both groups had similar rates of complications.
The present modification of a conventional cocktail significantly prolonged the analgesic effect and reduced pain medication consumption after UKA surgery, which was associated with better functional recovery in the early postoperative days.
Chinese Clinical Trial Registry, ChiCTR2200060500. 21 March 2023.
关节周围局部浸润镇痛（LIA）已成为单髁膝关节置换术（UKA）后术后疼痛管理的广泛应用方法。然而，在 UKA 中使用硫酸镁或碳酸氢钠的 LIA 鸡尾酒的疗效尚不清楚。本研究旨在评估改良 LIA 是否在 UKA 手术后的疼痛控制和关节功能恢复方面具有优势。
纳入 61 例接受 UKA 的患者，随机分为接受关节周围浸润改良鸡尾酒（含罗哌卡因、肾上腺素、地塞米松、硫酸镁和碳酸氢钠）或常规鸡尾酒（含罗哌卡因、肾上腺素、地塞米松、酮咯酸和吗啡）的患者。观察指标包括术后使用患者自控静脉镇痛（PCIA）药物的剂量、疼痛评分、早期关节功能恢复、出院时间和并发症发生率。
术后 12 h 内，常规鸡尾酒在视觉模拟评分（VAS）方面并不优于改良鸡尾酒，但从术后第 2 天开始，改良组的镇痛效果明显延长，VAS 评分较低，膝关节功能恢复较好。此外，改良组患者在术后第 1 天和第 2 天的 PCIA 止痛药用量均明显少于常规组，累积至术后 48 h 时，差异有统计学意义。两组并发症发生率相似。
本研究中对常规鸡尾酒的改良显著延长了 UKA 术后的镇痛效果，减少了术后疼痛药物的使用，与术后早期更好的功能恢复相关。
中国临床试验注册中心，ChiCTR2200060500。2023 年 3 月 21 日。
