Effects of perioperative analgesic technique on the surgical outcome and duration of rehabilitation after major knee surgery
Effects of perioperative analgesic technique on the surgical outcome and duration of rehabilitation after major knee surgery
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DOI：
10.1097/00000542-199907000-00006
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发表时间：
1999-07-01
期刊：
影响因子：
8.8
通讯作者：
d'Athis, F
中科院分区：
文献类型：
--
作者：
Capdevila, X;Barthelet, Y;d'Athis, F
背景：膝关节大手术后持续被动活动可优化功能预后，但会引起严重疼痛。作者检验了术后镇痛技术影响手术结果和恢复期的假设。方法：在标准化全身麻醉前，56例拟行膝关节手术的成人随机分为三组，每组接受不同的术后镇痛技术72 h：连续硬膜外输注、连续股静脉阻滞或静脉内患者自控吗啡（剂量，1 mg;锁定间隔，7 min;最大剂量，30 mg/4 h）。前两种技术使用1%利多卡因、0.03 mg/ml吗啡和2 μ g/ml可乐定的溶液以0.1 ml kg-1 h-1给药。在休息时和连续被动运动期间使用视觉模拟量表评估疼痛。术后24 h和48 h连续被动活动期间测量早期膝关节屈曲最大幅度，并与外科医生规定的目标水平进行比较。为了评价功能结局，在术后第5天、出院时（第7天）以及1个月和3个月随访检查时再次测量最大振幅。当病人离开外科病房，他们被接纳到康复中心，在那里他们的住院时间取决于前瞻性确定的出院criterions.Results：连续硬膜外输液和连续股动脉阻滞组表现出显着较低的视觉模拟量表评分在休息和持续被动运动与病人控制的吗啡组相比。连续硬膜外输注组和连续股动脉阻滞组的术后早期膝关节活动水平比患者对照吗啡组更接近外科医生规定的目标水平。术后第7天，连续硬膜外输注组、连续股动脉阻滞组和吗啡组的上述数值分别为90 °（60-100 °）、90 °（60-100 °）和80 °（60 - 100 °）（中位数和25 ~ 75 °）（P < 0.05）。在康复中心的住院时间：硬膜外持续输注组为37天（30-45天），连续股动脉阻滞组为40天（31-60天），吗啡组为50天（30-80天），差异有统计学意义（P < 0.05）。在连续硬膜外输液group.Conclusion：区域性镇痛技术，提高早期康复膝关节手术后，有效地控制疼痛持续被动运动，从而加快康复。
Background: Continuous passive motion after major knee surgery optimizes the functional prognosis but causes severe pain. The authors tested the hypothesis that postoperative analgesic techniques influence surgical outcome and the duration of convalescence.Methods: Before standardized general anesthesia, 56 adult scheduled for major knee surgery were randomly assigned to one of three groups, each to receive a different postoperative analgesic technique for 72 h: continuous epidural infusion, continuous femoral block, or intravenous patient-controlled morphine (dose, 1 mg; lockout interval, 7 min; maximum dose, 30 mg/4 h). The first two techniques were performed using a solution of 1% lidocaine, 0.03 mg/ml morphine, and 2 mu g/ml clonidine administered at 0.1 mi kg-l h-l. Pain was assessed at rest and during continuous passive motion using a visual analog scale. The early postoperative maximal amplitude of knee flexion was measured during continuous passive motion at 24 h and 48 h and compared with the target levels prescribed by the surgeon. To evaluate functional outcome, the maximal amplitudes were measured again on postoperative day 5, at hospital discharge (day 7), and at 1- and 3-month follow-up examinations. When the patients left the surgical ward, they were admitted to a rehabilitation center, where their length of stay depended on prospectively determined discharge criteria.Results: The continuous epidural infusion and continuous femoral block groups showed significantly lower visual analog scale scores at rest and during continuous passive motion compared with the patient-controlled morphine group. The early postoperative knee mobilization levels in both continuous epidural infusion and continuous femoral block groups were significantly closer to the target levels prescribed by the surgeon than in the patient-controlled morphine group. On postoperative day 7, these values were 90 degrees (60-100 degrees) (median and 25th-75th percentiles) in the continuous epidural infusion group, 90 degrees (60-100 degrees) in the continuous femoral block group, and 80 degrees (60-100 degrees) in the patient-controlled morphine group (P < 0.05). The durations of stay in the rehabilitation center were significantly shorter: 37 days (range, 30-45 days) in the continuous epidural infusion group, 40 days (range, 31-60 days) in the continuous femoral block group, and 50 days (range, 30-80 days) in the patient-controlled morphine group (P < 0.05). Side effects were encountered more frequently in the continuous epidural infusion group.Conclusion: Regional analgesic techniques improve early rehabilitation after major knee surgery by effectively controlling pain during continuous passive motion, thereby hastening convalescence.