不同局部镇痛方式对踝关节外侧韧带修复术后早期镇痛的随机对照研究
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摘要
目的采用随机对照研究观察不同方法对踝关节韧带修复术后镇痛效果。方法纳入2017年1月至2018年8月确诊的踝关节外侧韧带损伤合并踝关节不稳定患者共69例。其中男性60例,女性9例,年龄(25.7±8.2)岁。所有患者均在充分知情同意基础之上随机予以踝关节周围阻滞镇痛及伤口鸡尾酒注射镇痛。采用视觉疼痛评分(VAS)法对两组患者术后3、6、12小时疼痛进行评估。结果在术后3小时早期评测中,鸡尾酒组疼痛感明显小于神经阻滞组(χ~2=13.074,P=0.005)。术后6、12小时对比无明显差异。结论局部鸡尾酒注射术后早期(3小时)效果优于踝关节周围浸润阻滞。
Objective A randomized controlled study was conducted to observe the analgesic effect of different methods after ankle ligament repair. Methods A total of 69 patients(60 male, 25.7±8.2 years) underwent lateral ankle ligament repair were randomized into local nerve block group and cocktail injection group. Visual Analogue Scale(VAS) was evaluated in 3, 6, 12 hours after surgery, the outcome of the two groups were compared. Results AcIn the early evaluation of 3 h after operation, the pain of cocktail group was significantly less than that of nerve block group(χ~2=13.074, P=0.005). While 6 h and 12 h showed no significant difference in VAS scale. Conclusion Cocktail injection perform better in early post-operative analgesia than local nerve block in lateral ankle ligament repair.
Objective A randomized controlled study was conducted to observe the analgesic effect of different methods after ankle ligament repair. Methods A total of 69 patients(60 male, 25.7±8.2 years) underwent lateral ankle ligament repair were randomized into local nerve block group and cocktail injection group. Visual Analogue Scale(VAS) was evaluated in 3, 6, 12 hours after surgery, the outcome of the two groups were compared. Results AcIn the early evaluation of 3 h after operation, the pain of cocktail group was significantly less than that of nerve block group(χ~2=13.074, P=0.005). While 6 h and 12 h showed no significant difference in VAS scale. Conclusion Cocktail injection perform better in early post-operative analgesia than local nerve block in lateral ankle ligament repair.
引文
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[14]Zhao X,Qin J,Tan Y,et al.Efficacy of steroid addition to multimodal cocktail periarticular injection in total knee arthroplasty:a metaanalysis[J].J Orthop Surg Res,2015,22(10):75.
[15]殷臣竹,张兰,吴文知,等.股骨外侧旁入路连续坐骨神经阻滞用于足踝手术后自控镇痛的效果[J].中华麻醉学杂志,2017,37(6):678-680.
[16]Alzeftawy AE,Elsheikh NA.Elsheikh.The effect of preemptive ankle block using ropivacaine and dexamethasone on postoperative analgesia in foot surgery[J].Anesth Essays Res,2017,11(2):372-375.
[17]Bj?rn S,Linde F,Nielsen KK,et al.Effect of perineural dexamethasone on the duration of single injection saphenous nerve block for analgesia after major ankle surgery:a randomized,controlled study[J].Reg Anesth Pain Med,2017,42(2):210-216.
[2]Doherty C,Bleakley C,Hertel J,et al.Locomotive biomechanics in persons with chronic ankle instability and lateral ankle sprain copers[J].J Sci Med Sport,2016,19(7):524-530.
[3]Hershkovich O,Tenenbaum S,Gordon B,et al.A large-scale study on epidemiology and risk factors for chronic ankle instability in young adults[J].J Foot Ankle Surg,2015,54(2):183-187.
[4]江少华,洪劲松.全镜下距腓前韧带修复术[J].足踝外科电子杂志,2016,3(3):62.
[5]Guillo S,Takao M,Calder J.et al.Arthroscopic anatomical reconstruction of the lateral ankle ligaments[J].Knee Surg Sports Traumatol Arthrosc,2016,24(4):998-1002.
[6]McGovern RP,Martin RL.Managing ankle ligament sprains and tears:current opinion[J].Open Access J Sports Med,2016,2(7):33-42.
[7]梁海东,刘学晖,童致虹.踝关节外侧韧带损伤的治疗进展[J].足踝外科电子杂志,2016,3(2):59-61.
[8]Anand P,Wilson R,Sheehy EC.Intraligamental analgesia for postoperative pain control in children having dental extractions under general anaesthesia[J].Eur J Paediatr Dent,2005,6(1):10-15.
[9]Chou LB,Wagner D,Witten DM,et al.Postoperative pain following foot and ankle surgery:a prospective study[J].Foot Ankle Int,2008,29(11):1063-1068.
[10]Brennan F,Carr DB,Cousins M.Pain management:A fundamental human right[J].Anesth Analg,2007,105(1):205-221.
[11]Ikeuchi M,Kamimoto Y,Izumi M,et al.Effects of dexamethasone on local infiltration analgesia in total knee arthroplasty:a randomized controlled trial[J].Knee Surg Sports Traumato Arthrosc opy,2014,22(7):1638-1643.
[12]吕毅,唐加华,李颖川.足踝手术患者术后疼痛管理进展[J].昆明医科大学学报,2016,37(8):139-142.
[13]Gottschalk A,Burmeister MA,Radtke P,et al.Continuous wound infiltration with ropivacaine reduces pain and analgesic requirement after shoulder surgery[J].Anesth Analg,2003,97(4):1086-1091.
[14]Zhao X,Qin J,Tan Y,et al.Efficacy of steroid addition to multimodal cocktail periarticular injection in total knee arthroplasty:a metaanalysis[J].J Orthop Surg Res,2015,22(10):75.
[15]殷臣竹,张兰,吴文知,等.股骨外侧旁入路连续坐骨神经阻滞用于足踝手术后自控镇痛的效果[J].中华麻醉学杂志,2017,37(6):678-680.
[16]Alzeftawy AE,Elsheikh NA.Elsheikh.The effect of preemptive ankle block using ropivacaine and dexamethasone on postoperative analgesia in foot surgery[J].Anesth Essays Res,2017,11(2):372-375.
[17]Bj?rn S,Linde F,Nielsen KK,et al.Effect of perineural dexamethasone on the duration of single injection saphenous nerve block for analgesia after major ankle surgery:a randomized,controlled study[J].Reg Anesth Pain Med,2017,42(2):210-216.