多模式镇痛在全膝关节置换术中的疗效评价

目的：探讨联合关节周围注射镇痛药物和持续静脉镇痛的多模式镇痛对全膝关节置换术（total knee arthroplasty,TKA）患者功能恢复的疗效。方法：60例拟行单侧TKA的患者完全随机分为实验组（28例）和对照组（28例）。所有患者术前48 h开始服用塞来昔布（西乐葆）200 mg/次,每天2次。实验组患者术中膝关节周围注射镇痛药物,术后给予持续静脉镇痛（continuous intravenousanalgesia,CIA）。对照组患者没有运用关节周围注射药物,仅给予术后CIA。记录术后CIA用量、各时间点静止视觉模拟疼痛评分（rest visual analogue score,RVAS）、被动活动视觉模拟疼痛评分（passive visual analogue score,PVAS）和膝关节活动度（range of mo-tion,ROM）,同时观察药物的毒副作用。结果：（1）实验组术后24、48 h内PCA的用量均显著低于对照组（P〈0.05）。（2）实验组术后4、8、12、24、48 h的RVAS和24、48 h的PVAS均显著低于对照组（P〈0.05）;术后72 h两组间RVAS和PVAS的差异均无统计学差异（P〉0.05）。（3）实验组术后第1、2、3 d的ROM均显著高于对照组（P〈0.05）,术后第l、2 w两组ROM之间的差异无统计学意义（P〉0.05）;实验组术后主动屈膝到90？所需的天数显著低于对照组（P〈0.05）。（4）实验组中恶心、呕吐和追加药物的发生率均显著低于对照组（P〈0.05）,未发现伤口感染、延期愈合及组织坏死等并发症。结论：联合使用关节周围注射镇痛药物和持续静脉镇痛的多模式镇痛方案,可以有效的缓解TKA患者术后早期的疼痛,促进患者膝关节的功能恢复,减少了单一用药所产生的不良反应。该方案安全有效、操作简单,是一种值得推广的TKA术后镇痛方法。

Effect of Multimodal Pain Relieve in Total Knee Arthroplasty

Objective： To evaluate the effect of multimodal pain relieve,periarticular analgesic drug injection combined with con-tinuous intravenous analgesia（CIA）,in total knee arthroplasty（TKA）.Methods： 56 TKA patients were randomly divided into experi-ment group（n=28） and control group（n=28）.All patients were given celecoxib 48 hours before operation 200 mg bid.All patients in ex-periment group received intraoperative periarticular injection of analgesic drugs,and then received CIA after operation.There was no drug injection around the joint but only CIA used in control group.Usage amount of CIA,rest visual analogue score,RVAS（RVAS）,passive visual analogue score（PVAS）,range of motion（ROM） of knee joint in every time point and side effects of drugs were recorded after surgery.Results：（1） Usage amount of CIA at 24,48 hours after operation in experiment were significantly fewer than those in con-trol group（P 0.05）.（2） RVAS at 4,8,12,24,48 hours and PVAS at 24,48 hours after operation in experiment were significantly lower than those in control group（P 0.05）.There were no significant differences in RVAS and PVAS at 72 hours after operation between two groups（P 0.05）.（3） ROM of knee at 1,2,3 days after operation in experiment group were significantly higher those in control group（P 0.05）.There were no significant differences at 1 and 2 weeks after operation between two groups（P 0.05）.The time to achieve knee flexion of 90 degrees in experiment group was significantly lower than that in control group（P 0.05）.（4）The incidences of nausea,emesis and additional use of drugs in experiment group were significantly lower than those in control group（P 0.05）.There were no complications of wound infection,delayed healing and tissue necrosis.Conclusions： The multimodal pain relieve,periarticular analgesic drug injection combined with CIA,can effectively relieve early postoperative pain of TKA patients,promote function recovery of knee joint and decrease incidence of side effects.The multimodal pain relieve,periarticular analgesic drug injection combined with CIA,is a safe,effective and easy analgesia method after TKA,which is worthy to widen application in clinic.