单膝人工关节置换术后多模式镇痛疗效评价

Effects of multimodal analgesia in pain management after unilateral total knee arthroplasty

  • 摘要: 目的 评价多模式镇痛对单膝人工关节置换术后的疗效。 方法 选择2014年9月- 2016年8月解放军总医院骨科四病区接受单膝关节置换术的骨关节炎患者90例,按围术期镇痛模式分成A、B、C组,每组30例。A组术前口服塞来昔布与盐酸曲马多,术中注射鸡尾酒式镇痛复合液,术后使用止疼泵;B组术前不使用药物,术中注射鸡尾酒式镇痛复合液,术后使用止疼泵;C组术前及术中不使用药物及鸡尾酒式镇痛复合液,仅术后使用止疼泵。对3组间的一般资料做统计学比较。观察并记录3组术后6 h、12 h、24 h、48 h、72 h及7 d的疼痛评分以及24 h、48 h、72 h及7 d时的关节活动度(range of motion,ROM)。 结果 三组一般资料差异无统计学意义。三组术后6 h疼痛评分A组(2.5±0.6)< B组(2.8±0.6)< C组(3.0±0.7),12 h评分A组(3.4±1.1)< B组(3.8±0.8)< C组(4.2±1.4),24 h评分A组(4.5±1.2)< B组(4.9±1.3)< C组(5.4±0.9),48 h评分为A组(5.6±1.4)< B组(6.1±1.3)< C组(6.3±1.4),组间差异及两两比较差异均有统计学意义(P< 0.05)。72 h及7 d的疼痛评分3组差异无统计学意义(P> 0.05)。三组术后24 h ROM A组(46.4±5.4)> B组(42.5±7.3)> C组(40.4±5.2),48 h ROM A组(58.6±4.2)> B组(56.2±4.7)> C组(53.3±6.1),72 h ROM A组(64.6±5.2)> B组(62.5±8.8)> C组(60.3±7.4),组间差异及两两比较差异均有统计学意义(P< 0.05)。7 d时ROM三组间差异无统计学意义(P> 0.05)。 结论 多模式镇痛对缓解单膝人工关节置换术后疼痛和改善关节活动度有积极作用。

     

    Abstract: Objective To study the effect of multimodal analgesia in pain management after unilateral total knee arthroplasty. Methods Ninety osteoarthritis patients who underwent unilateral TKA in our hospital from September 2014 to August 2016 were included in this study.They were divided into three groups with different analgesia regimens with 30 patients in each group.Group A: preoperative oral celecoxib and tramadol hydrochloride + periarticular "cocktail" injection during operation + patient controlled analgesia pump after surgery.Group B: periarticular “cocktail” injection during operation + patient controlled analgesia pump after surgery without preoperative drugs.Group C: patient controlled analgesia pump after surgery without preoperative drugs and periarticular "cocktail" injection during operation.Visual analogue scale scores and range of motion were selected as indicators of effects at several different time points after the surgery. Results No signi ficant difference was found in the demographic data of the three groups (P> 0.05).The VAS scores were recorded as A(2.5±0.6)< B(2.8±0.6)< C(3.0±0.7)at 6 h, A(3.4±1.1)< B(3.8±0.8)< C(4.2±1.4) at 12 h, A(4.5±1.2)< B(4.9±1.3)< C(5.4±0.9) at 24 h, and A(5.6±1.4)< B(6.1±1.3)< C(6.3±1.4) at 48 h after TKA (P< 0.05, respectively).No signi ficant difference was found between the three groups at 72 h and 7 d after TKA (P> 0.05).The ROM were recorded as A(46.4±5.4)> B(42.5±7.3)> C(40.4±5.2) at 24 h, A(58.6±4.2)> B(56.2±4.7)> C(53.3±6.1) at 48 h, A(64.6±5.2)> B(62.5±8.8)> C(60.3±7.4) at 72 h after TKA (P< 0.05, respectively).No signi ficant difference was found between the three groups at 7 d. Conclusion The study shows that multimodal analgesia bene fits to pain management and achieve better ROM in early stage after TKA.

     

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