骨科的多模式镇痛的临床实践.ppt

局 部 镇 痛 与 镇 痛 Intra-articular and periarticular injection during total knee arthroplasty has been studied. There is concern over the local effects, including susceptibility to short and long-term infection. Fu et al. studied eighty patients treated with total knee arthroplasty, half of whom had been randomized to receive an injection containing 5 mg of morphine, 30 mg of bupivacaine (15 mg/1.5 mL), and 1 mL of betamethasone88. The injection was administered into the soft tissues at various stages of the procedure. The patients who had received the intra-articular injection had decreased VAS pain scores and opioid use and an increased range of motion on postoperative day 15. There was no reported difference in the infection rate by twelve months or in wound-healing between the two groups. 关节腔注射尤其是膝关节置换术时除了要关注止痛效果外，还要考虑短期和长期感染的风险。膝关节置换术患者随机分为关节腔注射组和关节外软组织注射组，两组注射液均包含5mg吗啡、30mg布比卡因和1ml的倍他米松88。关节腔注射组的VAS评分较低，术后15天关节活动度较大。两组在12个月时的感染率和伤口愈合情况无差别。 In another study, the authors evaluated intra-articular injection containing 400 mg of ropivacaine, 30 mg of Toradol (ketorolac), 5 mg of morphine, and 0.6 mL of epinephrine (1:1000) in patients undergoing total knee arthroplasty89. The patients who had received the injection had lower VAS pain scores and higher VAS satisfaction scores. Opioid use was also decreased significantly (p 0.001) in the injection group. There was no mention of the infection rates; however, no nervous system or cardiac abnormalities were reported. 关节腔内注射400mg罗哌卡因、30mg酮咯酸、5mg吗啡和0.6ml的肾上腺素（1:1000）89。关节腔注射组患者VAS疼痛评分较低，VAS满意度评分较高，阿片需求量明显降低。 局 部 镇 痛 与 镇 痛 Most recently, Mullaji et al. examined patients who had been randomized to receive an intra-articular injection in one knee and no injection in the other knee during bilateral simultaneous total knee arthroplasty 90. Lower pain scores along with an improved short-term range of motion were recorded for the knees that had received the injection. 最近，Mullaji等报告了在双侧膝关节置换式患者的1个关节腔内注射90，另一个膝关节腔内不注射，结果发现关节腔内注射侧的疼痛评