CAJ | 학술논문

目的探讨局部浸润镇痛在初次单侧全膝关节置换(total knee arthroplasty,TKA)术后多模式镇痛中的作用及安全性.方法将60例拟行初次单侧TKA手术的患者随机分为局部浸润镇痛组与无局部浸润镇痛组,每组30例.两组均于术前3天给予塞来昔布口服(200 mg,2次/d),于手术室进行术侧股神经阻滞(3.3 g/L罗哌卡因30 ml).采用静脉吸入复合麻醉.局部浸润镇痛组于术中假体安放完毕后行切口局部浸润镇痛(2.5 g/L罗哌卡因60 ml+0.1 mg肾上腺素)；无局部浸润镇痛组不做切口局部浸润镇痛.术后均不使用静脉患者自控式镇痛泵.观察两组患者麻醉清醒后2、6、12、24、48、72 h及出院时的静息与活动疼痛视觉模拟评分(visual analogue scale,VAS)；术后24、48、72 h关节活动度、股四头肌肌力及镇痛相关不良反应发生率.结果局部浸润镇痛组术后各时点的静息及运动VAS评分均低于无局部浸润镇痛组,术后2h至48 h静息VAS及24 h以后运动VAS的差异有统计学意义.局部浸润镇痛组术后24、48、72 h及出院时膝关节活动度、股四头肌肌力优于无局部浸润镇痛组,首次直腿抬高时间早于无局部浸润镇痛组,对阿片类药物的需求(哌替啶35.0 mg/例)少于无局部浸润镇痛组(哌替啶66.7 mg/例),镇痛相关不良反应发生率(2/30,6.7％)低于无局部浸润镇痛组(7/30,23.3％),术后平均住院时间(5.4 d)少于无局部浸润镇痛组(6.8 d),差异均有统计学意义.结论以股神经阻滞联合局部浸润镇痛为主的多模式镇痛在初次单侧TKA术后有较好的镇痛效果.
목적 탐토국부침윤진통재초차단측전슬관절치환(total knee arthroplasty,TKA)술후다모식진통중적작용급안전성.방법 장60례의행초차단측TKA수술적환자수궤분위국부침윤진통조여무국부침윤진통조,매조30례.량조균우술전3천급여새래석포구복(200 mg,2차/d),우수술실진행술측고신경조체(3.3 g/L라고잡인30 ml).채용정맥흡입복합마취.국부침윤진통조우술중가체안방완필후행절구국부침윤진통(2.5 g/L라고잡인60 ml+0.1 mg신상선소)；무국부침윤진통조불주절구국부침윤진통.술후균불사용정맥환자자공식진통빙.관찰량조환자마취청성후2、6、12、24、48、72 h급출원시적정식여활동동통시각모의평분(visual analogue scale,VAS)；술후24、48、72 h관절활동도、고사두기기력급진통상관불량반응발생솔.결과 국부침윤진통조술후각시점적정식급운동VAS평분균저우무국부침윤진통조,술후2h지48 h정식VAS급24 h이후운동VAS적차이유통계학의의.국부침윤진통조술후24、48、72 h급출원시슬관절활동도、고사두기기력우우무국부침윤진통조,수차직퇴태고시간조우무국부침윤진통조,대아편류약물적수구(고체정35.0 mg/례)소우무국부침윤진통조(고체정66.7 mg/례),진통상관불량반응발생솔(2/30,6.7％)저우무국부침윤진통조(7/30,23.3％),술후평균주원시간(5.4 d)소우무국부침윤진통조(6.8 d),차이균유통계학의의.결론 이고신경조체연합국부침윤진통위주적다모식진통재초차단측TKA술후유교호적진통효과.
Objective To evaluate the efficacy and safety of local infiltration analgesia in the multimodal analgesia protocol.Methods Sixty patients who were scheduled to undergo TKA were randomly divided two groups:local infiltration analgesia (LIA) group (n=30) or the non-local infiltration analgesia (N-LIA) group (n=30).All patients were given Celecoxib 200 mg bid,3 days preoperative,and a single-injection femoral nerve block (SFNB) half an hour before the surgery (ropivacaine 3.3 g/L,30 ml).The LIA group was given local infiltration analgesia with ropivacaine (2.5 g/L,60 ml) and 0.1 mg epinephrine before suture the operative incision.The N-LIA group didn't do the LIA.Both of the two groups didn't use the patient controlled analgesia.The VAS scores,the knee joint range of motion,the muscle strength of quadriceps femoris and the side effects and complications were recorded.Results The VAS scores were lower in LIA group than in the N-LIA group,these scores at 2 h to 48 h after surgery at rest and after 24 h at motion had statistical significance.The range of motion and the muscular strength of quadriceps femoris in the LIA group were better than in the N-LIA group.In the LIA group the use of opioids was less and the side effects were lower.The average length of hospital stay after the operation was shorter in the LIA group than the N-LIA group.Conclusion This multimodal perioperative analgesia protocol that include SFNB and LIA offered improved pain control and minimal side effects to patients undergoing TKA.