Gatt C J, Parker R D, Tetzlaff J E, Szabo M Z, Dickerson A B
Department of Orthopaedics, Cleveland Clinic Foundation, Ohio 44195, USA.
Am J Sports Med. 1998 Jul-Aug;26(4):524-9. doi: 10.1177/03635465980260040901.
As more outpatient orthopaedic surgical procedures are performed, postoperative pain control has gained importance. The benefits of preemptive analgesia, the use of analgesics or anesthetics or both before painful stimuli to prevent or reduce pain, have been widely published in the anesthesia and general surgery literature, but not in orthopaedic literature. We prospectively compared the effects, on postoperative pain and narcotic use, of intraarticular preoperative injections of 1) placebo with epinephrine, 2) bupivacaine with epinephrine, and 3) bupivacaine and morphine with epinephrine. Thirty patients (10 in each group) underwent arthroscopic anterior cruciate ligament reconstruction using patellar tendon autograft under general anesthesia. Pain was assessed with a 10-point visual analog scale pre- and postoperatively, and postoperative narcotic pain medication use was recorded. Postoperative pain was significantly greater in group 1 (placebo) than in the preemptive-treatment groups (groups 2 and 3), and in group 2 than in group 3. The differences became less apparent with time, and after 1 hour, no significant differences in pain scores existed between the groups. However, intravenous narcotic pain medication was administered in the recovery room to patients with pain scores greater than 5, equalizing pain scores. Group 3 used significantly less postoperative narcotic medication than group 1. Preemptive analgesia using intraarticular bupivacaine and morphine with epinephrine resulted in lower pain scores during the 1st hour after an arthroscopic anterior cruciate ligament reconstruction than did preemptive treatment with bupivacaine and epinephrine or placebo and epinephrine.
随着越来越多的门诊骨科手术得以开展，术后疼痛控制变得愈发重要。超前镇痛（即在疼痛刺激前使用镇痛药或麻醉药或两者兼用，以预防或减轻疼痛）的益处已在麻醉学和普通外科学文献中广泛发表，但在骨科文献中却未见报道。我们前瞻性地比较了术前关节腔内注射以下三种药物对术后疼痛和麻醉药使用的影响：1）含肾上腺素的安慰剂；2）含肾上腺素的布比卡因；3）含肾上腺素的布比卡因和吗啡。30例患者（每组10例）在全身麻醉下接受了使用自体髌腱的关节镜下前交叉韧带重建术。术前和术后采用10分视觉模拟量表评估疼痛情况，并记录术后麻醉性镇痛药的使用情况。第1组（安慰剂组）术后疼痛明显高于超前治疗组（第2组和第3组），且第2组高于第3组。随着时间推移，这些差异变得不那么明显，1小时后，各组之间疼痛评分无显著差异。然而，对于疼痛评分大于5分的患者，在恢复室给予了静脉麻醉性镇痛药，使疼痛评分趋于相等。第3组术后使用的麻醉药明显少于第1组。与使用含肾上腺素的布比卡因或含肾上腺素的安慰剂进行超前治疗相比，使用含肾上腺素的关节腔内布比卡因和吗啡进行超前镇痛在关节镜下前交叉韧带重建术后第1小时内产生的疼痛评分更低。
