全膝关节置换围手术期多模式和超前镇痛方案的临床研究

目的：评价围手术期超前联合多模式镇痛方案在全膝关节置换术中的镇痛作用。方法：接受单侧全膝关节置换的患者54例，随机分成三组，每组18例，A组联合应用术前及活动前口服塞来昔布和氨酚曲马多及术中关节腔内注射鸡尾酒式镇痛混合剂多模式镇痛（联合组），B组应用术中关节腔内注射鸡尾酒式镇痛混合剂镇痛（多模式组），C组术后单独应用自控镇痛（对照组）。三组患者均在全麻下完成手术，记录三组患者术后6h、24h、72h以及术后7d静息状态下疼痛视觉模拟评分（visual analogue score，vas），记录术后24h、48h、72h以及7d患者活动状态下VAS评分，并记录术后24h、72h以及30d膝关节活动度及术后并发症的发生情况。结果：静息痛评分术后6h、24h、72h联合组与多模式组患者均显著低于对照组（P〈0．01），术后6h、24h联合组患者低于多模式组（P〈0．01）。活动痛评分术后24h、48h、72h比较联合组〈多模式组〈对照组（P〈0．01）。膝关节活动度术后24h、72h比较联合组〉多模式组〉对照组（P〈0．01）。术后并发症发生情况对照组明显高于其它两组。结论：全膝关节置换术围手术期超前联合多模式镇痛方案是一种简单、安全、有效的镇痛方法。

Multiple -model pain control with Preemptive analgesia methods for perioperative pain relief after unilateral total knee arthroplasty

Objective： To evaluate the effect of Multiple - model pain control with preemptive analgesia methods for perioperative pain relief after unilateral total knee aithroplasty（TKA）. Methods： fifty four patients suffered unilateral TKA were randomly divided into three groups according to the perioperafive pain relief method, group A with multiple- model pain control with preemptive analgesia , group B with multiple - model pain control and group C with fentabyl based patient-controlled analgesia （PCA）. In group A, the patients took celecoxib and paracetamol and tramadal hydrechloride tablets orally during perioperative period, and received intra- articular cocktail analgesic mixture injection. In group B the patients received intra- articular cocktail analgesic mixture injection. In group C, fentanyl based patient - controlled analgesia was used as the only postoperative pain relief method. Visual analogue score（VAS） for pain during activity and at rest ,range of motion and complications were assessed and compared between the three groups. Result： the group A and B had a significant lower VAS at 6, 24, 72 h postoperatively than group C （ P〈0.01）, while the VAS of rest pain of group A was lower than group B at 6, 24 h postoperatively. At the 24,48, 72 h postoperatively,the VAS of movement pain of group A was the lowest.group A 〈 group B〈groun C. （P〈0.01 ）. the range of motion of the knee at 24.72 h was the best m group A, group A 〉 group B〉 group C, （P〈0.01）. The occurrence of complications of group C was higher than the other groups. Conclusion： the multiple - model pain control with preemptive analgesia methods is a simple, safety and efficient pain control method for perioperative pain relief after TKA.