Brandsson S, Rydgren B, Hedner T, Eriksson B I, Lundin O, Swärd L, Karlsson J
Department of Orthopaedics, Ostra University Hospital, Göteborg, Sweden.
Knee Surg Sports Traumatol Arthrosc. 1996;4(4):200-5. doi: 10.1007/BF01567963.
The aim of this study was to evaluate the analgesic effect of an external cooling system with or without the combined effect of intra-articularly administered bupivacaine/morphine after arthroscopic anterior cruciate ligament (ACL) reconstruction. Fifty patients with isolated ACL insufficiency operated on under general anaesthesia were randomized to three different postoperative treatment groups. Group I was treated with the cooling system during the first 24 h after surgery and an intra-articular injection of 20 ml of physiological saline given at the completion of surgery; in group II, the cooling system was combined with an intra-articular injection of 20 ml bupivacaine 3.75 mg/ml and 1 mg of morphine at the end of the operation; while group III (placebo group) received an intra-articular injection of 20 ml of physiological saline at the completion of surgery. Pain was assessed using a visual analogue scale (VAS) at 1, 2, 4, 6, 24 and 48 h postoperatively. Supplementary analgesic requirements were registered. In group I 80% (16/20) and in group II 90% (18/20) of the patients were satisfied with the postoperative pain control regimen (NS). This was significantly better than in group III, where 30% (3/10) were satisfied. The pain scores were significantly lower in the two treatment groups compared with the placebo group during the entire postoperative period. The pain score was significantly lower in group II than in group I at 24 and 48 h after surgery. The supplementary analgesic requirements were also lower in the two treatment groups compared with the placebo group. No complications due to the use of the cooling system or the intra-articular injections of bupivacaine/morphine were observed. The external cooling system used in this study provides an effective method of obtaining pain relief after arthroscopic surgery. The combination with an intra-articular injection of morphine and bupivacaine results in a slightly greater analgesic effect than the cooling system alone.
本研究旨在评估关节镜下前交叉韧带（ACL）重建术后，外部冷却系统单独使用或联合关节内注射布比卡因/吗啡的镇痛效果。五十例在全身麻醉下接受单纯ACL损伤手术的患者被随机分为三个不同的术后治疗组。第一组在术后24小时内接受冷却系统治疗，并在手术结束时关节内注射20毫升生理盐水；第二组在手术结束时将冷却系统与关节内注射20毫升浓度为3.75毫克/毫升的布比卡因和1毫克吗啡联合使用；而第三组（安慰剂组）在手术结束时接受关节内注射20毫升生理盐水。术后1、2、4、6、24和48小时使用视觉模拟量表（VAS）评估疼痛程度，并记录补充镇痛药物的使用情况。第一组80%（16/20）和第二组90%（18/20）的患者对术后疼痛控制方案满意（无显著性差异）。这明显优于第三组，第三组只有30%（3/10）的患者满意。在整个术后期间，两个治疗组的疼痛评分均显著低于安慰剂组。术后24和48小时，第二组的疼痛评分显著低于第一组。两个治疗组的补充镇痛药物使用量也低于安慰剂组。未观察到因使用冷却系统或关节内注射布比卡因/吗啡而引起的并发症。本研究中使用的外部冷却系统为关节镜手术后缓解疼痛提供了一种有效的方法。与关节内注射吗啡和布比卡因联合使用比单独使用冷却系统的镇痛效果稍好。
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