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首页> 美国卫生研究院文献>Journal of Clinical Orthopaedics and Trauma >Periarticular injection and continuous femoral nerve block versus continuous femoral nerve block alone on postoperative opioid consumption and pain control following total knee arthroplasty: Randomized controlled trial
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Periarticular injection and continuous femoral nerve block versus continuous femoral nerve block alone on postoperative opioid consumption and pain control following total knee arthroplasty: Randomized controlled trial

机译：全膝关节置换术后术后阿片类药物的消耗和疼痛控制的比较关节腔注射和股神经连续阻滞与单独股神经阻滞比较：随机对照试验

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Continuous femoral nerve block (CFNB) has been used to prevent the breakthrough pain after total knee arthroplasty (TKA). Multimodal drug injection (PMDI) has also been shown to decrease opioid consumption and pain. We investigated whether the use of PMDI further improves analgesic and rehabilitation outcomes when used in conjunction with CFNB. This is a prospective randomized controlled study of 44 patients undergoing primary TKA. The treatment group (n = 23) received a PMDI of combined ropivacaine, epinephrine, ketorolac and morphine, and the controlled group (n = 21) received saline at wound closure. Total opioid consumption, pain scores, knee range of motion (ROM) outcomes, length of stay, and patient satisfaction were measured and compared. The total consumption of morphine is similar between the two groups (52.6 ± 40.6 vs. 41.5 ± 32.9, p = 0.325). The mean morphine consumption of the treatment group was significantly lower than the control at 4 h after surgery (4.2 ± 5.5 vs. 11.3 ± 8.1, p = 0.002) but comparable on POD1, POD2, and POD3. The mean pain scores were significantly higher in the treatment group than the control group at POD2 (at rest: 47.3 ± 29.1 vs. 23.8 ± 20.6, p = 0.004; after PT: 57.7 ± 25.4 vs. 35.2 ± 26.8, p = 0.007) and POD3 (at rest: 30.9 ± 30.3 vs. 14.8 ± 20.9, p = 0.045; after PT: 50.2 ± 30.6 vs. 29.0 ± 32.1, p = 0.035), and not significantly different at 4 h after surgery or at POD1. Mean maximal knee flexion ROM in degrees during active and active assisted mobilization showed no significant difference between the control and the treatment groups on POD2 and POD3. The mean length of stay of the treatment group is significantly longer than the control group (5.1 ± 2.1 vs. 3.8 ± 1.6, p = 0.032). At discharge, no significant difference exists between the two groups for mean patient satisfaction. The addition of PMDI led to a decrease in opioid consumption in the immediate postoperative period but with no significant difference in the total consumption within the first three days postoperatively. This finding provides an opportunity for appropriate preoperative treatment and education for both patients and caregivers.
机译：连续股神经阻滞（CFNB）已用于预防全膝关节置换术（TKA）后的穿刺疼痛。多模式药物注射（PMDI）也已显示可减少阿片类药物的消耗和疼痛。我们调查了与CFNB联合使用PMDI是否能进一步改善镇痛和康复效果。这是一项对44例接受原发性TKA的患者进行的前瞻性随机对照研究。治疗组（n = 23）接受罗哌卡因，肾上腺素，酮咯酸和吗啡的联合PMDI，对照组（n = 21）在伤口闭合时接受生理盐水。测量并比较了阿片类药物的总消耗量，疼痛评分，膝关节活动范围（ROM），住院时间和患者满意度。两组之间的吗啡总消耗量相似（52.6±40.6 vs.41.5±32.9，p = 0.325）。手术后4小时，治疗组的平均吗啡消耗量显着低于对照组（4.2±5.5比11.3±8.1，p = 0.002），但在POD1，POD2和POD3上相当。在POD2时，治疗组的平均疼痛评分显着高于对照组（休息时：47.3±29.1比23.8±20.6，p = 0.004; PT后：57.7±25.4 vs.35.2±26.8，p = 0.007）和POD3（静止时：30.9±30.3 vs. 14.8±20.9，p = 0.045; PT之后：50.2±30.6 vs. 29.0±32.1，p = 0.035），并且在手术后4小时或POD1时无显着差异。在主动和主动辅助动员过程中，平均最大膝关节屈曲ROM的度数在对照组和POD2和POD3的治疗组之间没有显着差异。治疗组的平均住院时间明显长于对照组（5.1±2.1对3.8±1.6，p = 0.032）。出院时，两组患者的平均满意度没有显着差异。 PMDI的添加可在术后即刻减少阿片类药物的摄入量，但术后前三天内总消耗量无显着差异。这一发现为患者和护理人员提供了适当的术前治疗和教育的机会。

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