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1、关节内置管局部浸润镇痛在全膝关节置换术的应用作者：曾金才 孙俊英 杨立文 王勇 魏立 刘宏鸣【摘要】［目的］观察使用关节内置管局部浸润镇痛对全膝关节置换术后镇痛的早期临床疗效。［方法］收集从2008年12月～2009年4月在本院行全膝关节置换术后采用置管镇痛者11例(12膝)。其中男3例，女8例，单侧手术者10例，同期双侧手术者1例。术前诊断：退变性骨关节炎8例，类风湿性关节炎2例，创伤后关节炎1例。所有患者围手术期镇痛方案均统一，术中关节周围注射“鸡尾酒”镇痛药液，并关节内置管术后1d单次追加
2、推注镇痛药液。记录患者术后1～3d疼痛VAS评分、总体满意度、膝关节活动度、主动直腿抬高时间及伤口并发症等。［结果］所有患者均未使用胃肠外阿片类药物，术后1～3d休息痛和运动痛VAS评分均获得显著改善，主动直腿抬高时间平均为2.6d，手术后第2d和第3d的膝关节平均主动活动度各为41°和55°，患者总体满意度高，无明显并发症。［结论］全膝关节置换术后经关节内置管多模式局部浸润镇痛，能显著延长术后镇痛时间，降低手术24h以后的休息痛、运动痛以及VAS评分，促进关节早日锻炼，提高患者满意度，且简单、
3、实用、安全、有效。【关键词】全膝关节置换术 局部浸润镇痛 关节内 置管 多模式镇痛13 Abstract:［Objective］Toobservethepostoperativeearlyefficacyofintraarticularcatheterlocalanestheticinfiltrationanalgesiafollowingtotalkneearthroplasty.［Methods］FromDecember2008toApril2009,elevenpatients(twel
4、veknees)undergoingtotalkneearthroplastywerereceivedthisanalgesiaprotocol,including3menand8women,allofthemwereperformedunilateraltotalkneearthroplasty,exceptfor1bilateralforRApatient.Preoperativediagnosisincluded8osteoarthritispatients,2rheumatoidarth
5、ritis,1posttraumaticarthritis.Theywereselectedthesameperioperativemultimodalanalgesiaprotocol,reveivingoneintraoperativeperiarticuiarinjectionmultimodaldrugsfluid“cocktailwine”,combinedwithonepostoperative1daysingle-shotintraarticularinjectionofthesa
6、mesubstancesthroughanintraarticularcatheter.Visualanalogscoresforpainatsometimepointupto3dayspostoperatively,totalsatisfactionscore,therangeofmotionofkneejoint,timeofactivestraightlegraisingandwoundcomplicationswerecollected.［Results］Allthepatientsdi
7、dnotuseparenteralopioids,theoverallVASpainscoreduringrestandexercisefor1～3dayspostoperativelywaslow.Timeofactivestraightleg13raisingwere2.6dayspostoperativelyinaverage.Duringthe2ndand3rddayspostoperatively,theaveragekneejointactivitywere41°and55°,the
8、totalsatisfactoryscoreofpatientswashigh,nootherapparentcomplicationswasfound.［Conclusion］Amultimodallocalinfiltrationanalgesiatechniqueusingintraarticularcatheterfollowingtotalkneearthroplastycansignificantlyprolongthepostoperativeanalgesia,reducepai
