术中局部镇痛药对股骨头坏死手术后镇痛的影响

Effect of Local Application of Mixed Analgesics drugs on the postoperative analgesia of Necrosis of Femoral Head

摘要:

目的 探讨局部应用混合镇痛药物对股骨头坏死行带血管蒂髂骨瓣转移术后的镇痛疗效。方法：回顾性分析2017年1月-2018年10月在大连大学附属中山医院骨关节中心行“带血管髂蒂骨瓣转移术”的股骨头坏死患者50例,年龄为18~40岁,平均年龄(33.32±3.05)岁,随机分为注射组26例(注射组术中髋周使用混合镇痛药物行局部浸润麻醉,混合镇痛药物(包括吗啡10mg、罗哌卡因268.2mg、曲安奈德50mg、头孢替唑钠1g,加生理盐水至100ml,)和对照组24例(对照组术中注射等量生理盐水)。对比评估：记录患者的一般资料；记录患者术后6h、12h、24h、48h、72h静息疼痛及对疼痛满意度的VAS评分；以及术后出现的副作用。结果：50例患者全部纳入结果分析。两组患者的一般资料比较无统计学差异；与对照组相比,注射组术后6h、12h、24h静息状态疼痛VAS评分明显降低(P<0.05)；两组患者对术后静息疼痛的满意度VAS评分在术后6小时内注射组明显高于对照组(P<0.05),具有统计学意义,在术后12~72h内的评分相近(P>0.05)；注射组术后阿片类药物消耗总量明显减少(P<0.05)；注射组有较低的术后并发症。结论：给予行“带血管蒂髂骨瓣转移术”的股骨头坏死患者,术中局部应用混合镇痛药物具有直视下操作简单的优势,在减少阿片类药物消耗量及并发症的基础上,有较好的早期镇痛效果。

Abstract:

Objective To investigate the local application of mixed analgesics drugs on femoral head necrosis after vascularized iliac bone flap transfer.Methods: A retrospective analysis was made on 50 cases of femoral head necrosis who underwent vascularized iliac pedicle bone flap transfer from January 2017 to October 2018 in the bone and joint center of Zhongshan Hospital affiliated to Dalian University. The age ranged from 18 to 40 years with an average age of 33.32 (+3.05). They were randomly divided into injection group (26 cases) and control group (24 cases). Contrastive evaluation: General data of patients were recorded; resting pain and VAS score of pain satisfaction at 6, 12, 24, 48 and 72 hours after operation were recorded; and side effects after operation were also recorded.Results: All 50 patients were included in the result analysis. There was no statistical difference in general data between the two groups; compared with the control group, the VAS score of resting state pain in the injection group decreased significantly at 6, 12 and 24 hours after operation (P < 0.05); the VAS score of patients"satisfaction with resting pain in the injection group was significantly higher than that in the control group within 6 hours after operation (P < 0.05), with statistical significance. The scores within 12 to 72 hours after operation were similar (P > 0.05); the total consumption of opioids in the injection group decreased significantly (P < 0.05); and the injection group had lower postoperative complications.Conclusion: local application of mixed analgesics drugs during operation has the advantage of simple operation under direct vision, and has better early analgesic effect on the basis of reducing the consumption of opioids and complications in the vascular pedicled iliac bone flap transfer for necrosis of femoral head .