中国组织工程研究

中国组织工程研究 ›› 2010, Vol. 14 ›› Issue (26): 4774-4777.doi: 10.3969/j.issn.1673-8225.2010.26.006

• 人工假体 artificial prosthesis • 上一篇    下一篇

布比卡因局部注射全膝关节置换者：镇痛效果及安全性评价

满振涛，李  伟，张  伟，孙  水，王  健，王先泉，李  斌   

  1. 山东大学附属省立医院关节外科，山东省济南市250021
  • 出版日期:2010-06-25 发布日期:2010-06-25
  • 通讯作者: 李 伟，博士，博士后，副主任医师，山东大学附属省立医院关节外科，山东省济南市 250021 greatli2000@ yahoo.com.cn
  • 作者简介:满振涛，男，1984年生，山东省平度市人，汉族，山东大学在读硕士，主要从事关节外科研究。 mztqd1984@163.com

Local injection of bupivacaine following total knee arthroplasty: Analgesia effect and safety evaluation

Man Zhen-tao, Li Wei, Zhang Wei, Sun Shui, Wang Jian, Wang Xian-quan, Li Bin   

  1. Department of Joint Surgery, Provincial Hospital Affiliated to Shandong University, Jinan  250021, Shandong Province, China
  • Online:2010-06-25 Published:2010-06-25
  • Contact: Li Wei, Doctor, Associate chief physician, Department of Joint Surgery, Provincial Hospital Affiliated to Shandong University, Jinan 250021, Shandong Province, China greatli2000@ yahoo.com.cn
  • About author:Man Zhen-tao, Studying for master’s degree, Department of Joint Surgery, Provincial Hospital Affiliated to Shandong University, Jinan 250021, Shandong Province, China mztqd1984@163.com

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摘要：

背景：为缓解人工全膝关节置换后疼痛，目前临床上常用静脉留置镇痛泵，口服或静脉应用止痛药物等方法，这些方法在一定程度上减轻了患者置换后疼痛，但静脉镇痛泵和口服药物的不良反应比较多，影响患者置换后的功能锻炼，增加了并发症的发生率。
目的：探讨手术区局部注射布比卡因行人工全膝关节置换后镇痛的疗效及安全性。
方法：选择2008-11-01/2009-12-31山东大学附属省立医院关节外科行人工全膝关节置换患者168例(218膝)，随机分成两组。干预组患者人工全膝关节置换过程中于术区周围多点注射布比卡因(成分：0.75%布比卡因10 mL+肾上腺素0.1 mg +生理盐水20 mL)；对照组人工全膝关节置换过程中不作局部镇痛处理。两组患者置换后均配用静脉留置镇痛泵，持续使用50 h。通过评估置换前、置换后患膝静止和活动时的目测类比评分，美国特种外科医院膝关节HSS评分比较两组镇痛效果。
结果与结论：干预组置换后4，8，12 h，患膝静止时和活动时目测类比评分均小于对照组(P < 0.05)。置换后3个月干预组膝关节HSS评分与对照组比较差异无显著性意义(P > 0.05)。干预组置换后有4例需要口服曲马多缓释片，16例仅用静脉止痛泵就能控制疼痛；对照组置换后有11例需要口服曲马多缓释片，9例仅用静脉止痛泵就能控制疼痛，两组间比较差异有显著性意义(P < 0.05)。结果提示人工全膝关节置换中关节周围广泛注射布比卡因，可明显缓解置换后早期疼痛，利于关节功能的早期锻炼康复，对近期疗效无不良影响。

关键词: 布比卡因, 人工全膝关节置换, 疼痛, 疗效, 膝关节假体

Abstract:

BACKGROUND: To ease the pain after total knee arthroplasty (TKA), intravenous catheter analgesia pumps, oral or intravenous pain medications are clinically used currently, which can reduce the pain of patients to some extent. However, intravenous analgesia pump and oral drugs have many side effects, such as affecting the functional exercise patients after the operation and increasing the incidence of complications.

OBJECTIVE: To investigate the efficacy and security of the local application of bupivacaine for pain after TKA.

METHODS: From November 1st, 2008 to December 31st, 2009, 168 patients (218 knees) undergoing TKA were selected from Department of Joint Surgery, Provincial Hospital Affiliated to Shandong University. Patients of the intervention group were injected with opite drugs (0.75%bupivacaine 10 mL+epinephrine 0.1 mg+saline 20 mL) in the surgical field around the knee. The control group did not use the anesthesia drug in the local area. Both groups used the intravenous analgesia pump for 50 hours. Visual analog scores and hospital for special surgery knee score for pain were recorded.

RESULTS AND CONCLUSION: Patients in the control group had higher visual analog scores for pain at rest and activity at hours 4, 8 and 12 postoperatively compared with the intervention group (P < 0.05). Three months after TKA, no significant difference was found for special surgery knee scores for pain between two groups (P > 0.05). Four patients in the intervention group took the tramadol sustained-release tablets after the operation, while there were eleven in the control group; sixteen patients in the intervention group could endure the pain with intravenous catheter analgesia pumps only, but only 9 patients in the control group (P < 0.05). In conclusion, intraoperative periarticular injection of bupivacaine in TKA can reduce the pain and improve range of motion at early time, but the injection had no adverse effect on TKA in a short term period.

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