解放军医药杂志2015，Vol.27Issue(9)：64-68,5.DOI:10.3969/j.issn.2095-140X.2015.09.013
全膝关节置换术围术期多模式超前镇痛的临床效果观察
Clinical Effect of Multi-mode Preemptive Analgesia on Patients Undergoing TKA during Perioperative Period
摘要
Abstract
Objective To investigate the effect of multi-mode preemptive analgesia on patients undergoing total knee arthroplasty ( TKA) during perioperative period. Methods A total of 60 osteoarthrosis of knee patients undergoing the first unilateral TKA during February 2013 and October were randomly divided into local infiltration analgesia group (group A, n=20), a single femoral nerve block analgesia group (group B, n=20) and traditional self-control venous pump analgesia group (group C, n=20). All patients received complex intravenous inhalation anesthesia. Group A and B were treated with 200 mg Celecoxib (2/d) orally 2 d before and after the TKA, and then local incision cold compress was performed after the surgery;at the same time, group A was given local infiltration analgesia (150 mg Ropivacaine +0. 1 mg Epinephrine);group B were given a single femoral nerve block analgesia (0. 375% Ropivacaine, 30 ml);group C was given venous pump analgesia ( 2 μg/kg Sufentanil + 100 mg Flurbiprofen Axetil ) . the visual analogue scale ( VAS) scores of knee joints at 6 h, 12 h, 1 d, 2 d, 3 d, 5 d and 7 d after the surgery, quadriceps femoris muscle power at 6 h, 12 h, 1 d, 2 d and 3 d after the surgery, genual range-of-motion ( ROM) at 1 d, 2 d and 3 d after the surgery, superaddition doses of Morphine and incidence rate of adverse events related analgesia in the three groups were recorded. Results The VAS scores at postoperative 6 h, 12 h, 1 d, 2 d, 3 d and 5d in group A and B were significantly decreased than those in group C (P<0. 05). The differences of quadriceps femoris muscle power at postoperative 6 h and 12 h were not statistically significant in the three groups (P>0. 05);the values of quadriceps femoris muscle power at postoperative 1 d, 2 d and 3 d in group A were significantly higher than those in group B (P<0. 05), but the differences in the values between group A and B with group C were not statistically significant (P<0. 05). The value of genual ROM at postopera-tive 1 d in group A was significantly higher than that in group C ( P<0. 05 ) , but the difference in the value between group B and C was not statistically significant (P>0. 05); the differences in genual ROM values at postoperative 1 d, 2 d and 3 d between group A and B were not statistically significant (P>0. 05), but the values in group A and B were all significantly higher than those in group C ( P<0. 05 ) . The difference in superaddition doses of Morphine between group A and B were not statistically significant (P>0. 05), and the values in group A and B were all significantly less than that in group C (P<0. 05). The difference in incidence rate of adverse events related analgesia between group A and B was not statistically significant (P>0. 05), and the rates in group A and B were all significantly lower than that in group C ( P<0. 05 ) . Conclusion Multi-mode preemptive analgesia has better effective than traditional venous pump analgesia with lower incidence rate of adverse events and better post-operation function recovery.关键词
关节成形术,置换/麻醉和镇痛/神经传导阻滞/塞来昔布/罗哌卡因Key words
Arthroplasty/replacement/Anesthesia and analgesia/Nerve block/Celecoxib/Ropivacaine分类
医药卫生引用本文复制引用
焦顺成,申海波,杜立,曹立峰,王振堂..全膝关节置换术围术期多模式超前镇痛的临床效果观察[J].解放军医药杂志,2015,27(9):64-68,5.基金项目
国际科技合作计划项目资助(2010DFA31250) （2010DFA31250）
