老年患者全髋关节置换术后携带利多卡因局部镇痛泵的疗效The effectiveness of continuous local infiltration of lidocaine after total hip arthroplasty in the elderly
熊自强;程文俊;王俊文;郑琼;左伟;马德彰;勘武生;
摘要(Abstract)：
[目的]探讨携带利多卡因局部镇痛泵在全髋关节置换术后镇痛中的疗效。[方法]将60岁以上初次全髋关节置换病例分为两组,一组术后伤口放置局部镇痛泵持续缓释利多卡因(局部镇痛泵组),一组术后使用静脉镇痛泵(patient controlled intra-venous analgesia,PCIA)输入稀释芬太尼(PCIA组)。比较两组术后静息疼痛视觉模拟评分(visual analogue scale,VAS);伤口延期愈合率、感染率;头晕、恶心、呕吐、尿潴留发生率;镇痛泵依从性比率。[结果]局部镇痛泵组术后1h VAS评分高于静脉镇痛泵组(P=0.016),术后2 h VAS评分与PCIA组相比差异无统计学意义(P=0.510),局部浸润组术后24 h(P=0.024)、48 h(P=0.012)VAS评分低于静脉镇痛组,差异有统计学意义。术后3 h后局部镇痛泵组应用额外镇痛药比例低于PCIA组(P=0.015),局部镇痛泵者依从性优于PCIA组(P<0.001)。局部镇痛组术后头晕、恶心、呕吐、尿潴留发生率均低于静脉镇痛组,差异有统计学意义;伤口延期愈合率两组差异无统计学意义;两组均无伤口感染。[结论]对于老年全髋关节置换患者,局部镇痛泵持续静息镇痛效果优于PCIA泵,能明显减少患者头晕、恶心、呕吐、尿潴留发生率;全身麻醉患者,局部镇痛泵应用时如果配合术中伤口局部浸润麻醉或者术后早期辅助额外小剂量镇痛药物镇痛效果可能更加理想。
关键词(KeyWords)： 关节成形术;置换;髋;麻醉和镇痛
基金项目(Foundation):
作者(Author): 熊自强;程文俊;王俊文;郑琼;左伟;马德彰;勘武生;
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参考文献(References)：
- [1]Rothwell MP,Pearson D,Hunter JD,et al.Oral oxycodone offers equivalent analgesia to intravenous patient-controlled analgesia after total hip replacement:a randomized,single-centre,non-blinded,noninferiority study[J].Br J Anaesth,2011,106(6):865-872.
- [2]Nishio S,Fukunishi S,Juichi M,et al.Comparison of continuous femoral nerve block,caudal epidural block,and intravenous patient-controlled analgesia in pain control after total hip arthroplasty:a prospective randomized study[J].Orthop Rev(Pavia),2014,6(1):15-19.
- [3]Solovyova O,Lewis CG,Abrams JH,et al.Local infiltration analgesia followed by continuous infusion of local anesthetic solution for total hiparthroplasty:a prospective,randomized,double-blind,placebocontrolled study[J].J Bone Joint Surg Am,2013,95(21):1935-1941.
- [4]董玉雷,吴志宏,翁习生,等.伤口周围缓释浸润利多卡因控制关节置换术后疼痛的随机对照研究[J].中华骨科杂志,2014,34(6):605-611.
- [5]Pandazi A,Kanellopoulos I,Kalimeris K,et al.Periarticular infiltration for pain relief after total hip arthroplasty:a comparison with epidural and PCA analgesia[J].Archo Orthop Trauma Surg,2013,133(11):1607-1612.
- [6]Andersen KV,Pfeiffer-Jensen M,Haraldsted V,et al.Reduced hospital stay and narcotic consumption,and improved mobilization with local and intraarticular infilation after hip arthroplasty:a randomized clinical trial of an intraarticular technique versus epidural infusion in80 patients[J].Acta Orthop,2007,78(2):180-186.
- [7]Revie EJ,Mc Keown DW,Wilson JA,et al.Randomized clinical trial of local infiltration plus patient-controlled opiate analgesia vs.epidural analgesia following liver resection surgery[J].HPB(Oxford),2012,14(9):611-618.
- [8]Guo D,Cao XW,Liu JW,et al.Continuous intra-articular infusion anesthesia for pain control after total knee arthroplasty:study protocol for a randomized controlled trial[J].Trials,2014,15(1):245.