背景:全膝关节置换术(TKA)是治疗晚期膝骨关节炎的主要手术方法。成功的TKA的基石是快速有效的康复,以实现无痛和良好的运动范围。置换后的疼痛阻碍了有效的康复方案。术前报告,围手术期,术后镇痛模式有不良副作用。这项研究的目的是使用视觉模拟评分评估独特的鸡尾酒注射对术后即刻疼痛的影响,在最初阶段需要额外的镇痛药,以及病例组和对照组的下床时间。
方法:在本随机对照研究中,关节周围注射罗哌卡因0.75mg/ml(28ml),肾上腺素1毫克/毫升(0.5毫升),和酮咯酸30mg/ml(1ml)加入到50ml生理盐水中制成80ml溶液。选择了50名患者,并通过计算机生成的随机化将其随机分为两组,每组25名。病例组接受了鸡尾酒注射,对照组局部注射生理盐水。在手术后3、6、12和24小时评估视觉模拟量表(VAS),并评估了额外镇痛药的使用量和下床时间。
结果:选择接受TKA的患者50例,分为病例组和对照组,每组25例。大多数患者患有骨关节炎,和一些有类风湿性关节炎。人口统计数据无显著差异(年龄,性别,体重指数)或手术时间。病例组在3、6、12和24小时的VAS评分在0和3之间(p<.001)。在第1天,病例组中96%的患者所需的额外镇痛量最小(<3次剂量)。超过80%的患者在第1天可以无痛行走。
结论:在使用这种独特的术中局部鸡尾酒注射的大量个体中,早期下床活动可减少疼痛。TKA之后的无痛初期为患者准备了有效的康复计划。
BACKGROUND: Total knee arthroplasty (TKA) is a leading operative procedure for late-stage knee osteoarthritis. The cornerstone of a successful TKA is swift and effective rehabilitation to achieve a pain-free and good range of motion. Pain post-replacement hinders an effective rehabilitation protocol. Reported preoperative, perioperative, and postoperative analgesia modes have undesirable side effects. The purpose of this study is to assess the effect of a unique cocktail injection on immediate postoperative pain using the visual analog score, the need for additional analgesics during the initial period, and the ambulation time between the
case and control groups.
METHODS: In this randomized case-control study, the periarticular injection consisted of ropivacaine 0.75 mg/ml (28 ml), epinephrine 1 mg/ml (0.5 ml), and ketorolac 30 mg/ml (1 ml) added to 50 ml of normal saline to make 80 ml of solution. Fifty patients were chosen and randomly divided into two groups of 25 each by computer-generated randomization. The
case group received the cocktail injection, and the control group was injected locally with normal saline. Visual analog scale (VAS) was assessed at 3, 6, 12, and 24 hr post-surgery, and the amount of additional analgesics used and ambulation time were assessed.
RESULTS: A total of 50 patients who underwent TKA were selected and divided into
case and control groups of 25 each. The majority of the patients had osteoarthritis, and a few had rheumatoid arthritis. No significant differences in demographic data (age, gender, body-mass index) or surgical time. The
case group had excellent VAS scores between 0 and 3 at 3, 6, 12, and 24 hr (p < .001). The amount of additional analgesia required in the
case group was minimal (<3 doses) in 96% of the patients on Day 1. More than 80% of patients could ambulate pain-free on Day 1.
CONCLUSIONS: Pain reduction with early ambulation was noted in a significant number of individuals with the use of this unique intraoperative local cocktail injection. This pain-free initial period following TKA prepared patients for an effective rehabilitation program.