目的

探讨不同方案“鸡尾酒”对全膝关节置换（TKA）术后早期疼痛控制的效果对比。

方法

回顾性分析2023年1月至2024年6月在深圳市人民医院因骨关节炎行全膝关节置换术的114例患者资料，除外双侧同期置换的患者。依据术中“鸡尾酒”配方和给药方式情况分为4组：含吗啡+关节内灌注组（吗啡灌注组）；含吗啡+关节周围注射组（吗啡注射组）；不含吗啡+关节内灌注组（灌注组）；不含吗啡+关节周围注射组（注射组）。方差分析4组患者术中“鸡尾酒”操作时间、术后24、72 h的视觉模拟评分（VAS）、术后24/72 h膝关节活动度（ROM），卡方检验分析术后72 h内追加止痛药物比例以及术后72 h内不良反应发生情况。

结果

4组患者术后24、72 h的VAS评分（F=0.363、0.474）、术后24、72 h的膝关节ROM（F=0.719、1.606）以及72 h内追加止痛药物比例（χ²=0.259）差异均无统计学意义（均为P>0.05）。术中关节内灌注“鸡尾酒”操作时间（9.5±1.8）s明显少于关节周围注射（41.2±4.9）s (t=47.60，P<0.001），且不含吗啡的两组患者术后72 h内不良反应总体发生率明显低于含吗啡的两组(χ²=8.961，P=0.027)，主要表现为恶心呕吐方面（χ²=7.917，P=0.046），而尿潴留、下肢深静脉血栓形成（DVT）以及周围神经损伤等并发症发生情况，差异无统计学意义（P>0.05）。

结论

术中关节内灌注不含吗啡的“鸡尾酒”对TKA术后早期疼痛控制有效，术中操作时间更短，术后早期并发症发生率更低，值得临床推广。

Objective

To explore the effect of different protocol “cocktail” on early pain control after total knee arthroplasty.

Methods

A total of 114 patients undergoing total knee arthroplasty for osteoarthritis in Shenzhen People's Hospital from January 2023 to June 2024 were enrolled, and the patients with bilateral concurrent replacement were excluded.The patients were divided into four groups according to the intraoperative cocktail formula and administration routes: with morphine + intra-articular perfusion group(morphine perfusion group); with morphine + periarticular injection group (morphine injection group); without morphine + intra-articular perfusion group (perfusion group); without morphine + peri-articular injection group(injection group).Analysis of variance (ANOVA) was used to analyze the intraoperative “cocktail” operation time,visual analog scale (VAS) at 24 h and 72 h after surgery, knee joint range of motion (ROM) at 24 h and 72 h after surgery, the proportion of additional analgesic drugs at 72 h after surgery and the occurrence of adverse reactions at 72 h after surgery were analyzed by chi square test.

Results

There was no statistically significant difference inVAS score at 24 h and 72 h after surgery (F=0.363, 0.474), ROM of knee joint at 24 h and 72 h after surgery (F=0.719, 1.606), and the proportion of additional analgesics administered within 72 h (χ²=0.259)(all P>0.05) However, intra-articular perfusion “cocktail” took significantly less operative time (9.5±1.8) s than periarticular injection (41.2±4.9) s (t=-47.60, P<0.01).The overall incidence of adverse reactions within 72 h after surgery was significantly lower in the two groups without morphine than in the two groups with morphine(χ²=8.961, P=0.027), The main manifestations were nausea and vomiting (χ²=7.917, P=0.046).There was no statistically significant difference in incidence of urinary storage, deep vein thrombosis (DVT) or peripheral nerve injury (P>0.05).

Conclusion

Intra-articular perfusion without morphine ＂cocktail＂, which is not only effective for early pain control after TKA, but also has shorter intraoperative operation time and lower incidence of early postoperative complications, is worthy of clinical promotion.