不同药物配方对全膝关节置换术局部浸润镇痛作用的影响

发布时间：2018-02-23 17:22

本文关键词： 股神经局部浸润镇痛术后镇痛全膝关节置换　出处：《中国药物警戒》2016年10期 　论文类型：期刊论文

【摘要】：目的比较局部浸润镇痛不同药物配方对全膝关节置换术患者术后镇痛效果。方法将150例拟行单侧膝关节置换术患者随机分为3组:R组、RF组与RM组,每组50例。3组患者均使用腰麻。R组配方为:罗哌卡因100 mg加生理盐水至50 m L。RF组配方为:罗哌卡因100 mg加芬太尼100μg加生理盐水至50 m L。RM组配方为:罗哌卡因100 mg+甲泼尼龙40 mg加生理盐水至50 m L。术毕连续股神经阻滞镇痛(CFNB)。镇痛不足时由医师根据患者疼痛程度给予肌内注射哌替啶50 mg。记录术后静息状态下4、8、12、16、24、36、48 h的疼痛视觉模拟评分(VAS)和术后24、36、48 h被动功能锻炼时疼痛VAS评分及并发症。结果 3组疼痛VAS评分在静息状态下术后4、8 h时无显著性差异,术后12、24、36和48 h时RM组疼痛VAS评分均比R组和RF组低(P0.01),而R组与RF组在各个观察时点疼痛VAS评分均无显著性差异。RM组功能锻炼时疼痛VAS评分均比R组和RF组明显低(P0.01),而R组与RF组无明显差异。R组和RF组在术后静息状态下肌注补充镇痛药哌替啶的药量明显比RM组高(P0.01)。结论膝关节置换术局部浸润镇痛配方建议使用罗哌卡因联合甲泼尼龙,不建议联合芬太尼。
[Abstract]:Objective to compare the analgesic effect of local invasive analgesia with different formulations for total knee arthroplasty. Methods 150 patients with unilateral knee arthroplasty were randomly divided into 3 groups: RF group and RM group. The formula of ropivacaine 100 mg plus normal saline to 50 m L RF group was ropivacaine 100 mg plus fentanyl 100 渭 g plus normal saline to 50 m L RM group: ropivacaine 100 mg + fentanyl 100 渭 g and ropivacaine 100 mg. Methylprednisolone 40 mg plus normal saline to 50 mL. After operation, continuous femoral nerve block analgesia was performed. When the analgesia was insufficient, the physician gave pethidine 50 mg intramuscularly according to the degree of pain of the patient. The pain vision of 48 hours after operation was recorded under the condition of rest. Results there was no significant difference in pain VAS scores and complications between the three groups during passive exercise at 24: 36 and 48 hours after passive exercise. Results there was no significant difference in pain VAS scores between the three groups at 4 to 8 hours after the operation. The pain VAS score of RM group was lower than that of R group and RF group at 12h 24 h and 48 h after operation, but there was no significant difference in pain VAS score between R group and RF group at each observation time. The pain VAS score of RM group was significantly lower than that of R group and RF group during functional exercise. There was no significant difference between group R and group RF. The dosage of pethidine was significantly higher in group R and RF than that in group RM. Conclusion ropivacaine combined with methylprednisolone is recommended for local invasive analgesia of knee arthroplasty. Combination of fentanyl is not recommended.
【作者单位】：北京积水潭医院;
【分类号】：R687.4

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