Local Efficacy of Periarticular Morphine Injection in Simultaneous Bilateral Total Knee Arthroplasty: A Prospective, Randomized, Double-Blind Trial
Local Efficacy of Periarticular Morphine Injection in Simultaneous Bilateral Total Knee Arthroplasty: A Prospective, Randomized, Double-Blind Trial
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DOI：
10.1016/j.arth.2017.07.020
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发表时间：
2017-12-01
影响因子：
3.5
通讯作者：
Nakamura, Hiroaki
中科院分区：
文献类型：
--
作者：
Iwakiri, Kentaro;Ohta, Yoichi;Nakamura, Hiroaki
背景资料：包括吗啡在内的关节周围多模式鸡尾酒注射目前常用于减轻全膝关节置换术（TKA）后的术后疼痛。尽管有镇痛作用，但它经常引起恶心，这是阿片类药物的一种不良反应。术中关节周围注射吗啡是否对外周有效尚不确定。本研究的目的是评估是否增加吗啡单侧关节周围膝关节注射改善术后疼痛，活动范围，肿胀的患者同时进行双侧TKA. Methods：一项前瞻性，单中心，双盲，随机，对照试验进行了评估局部疗效增加吗啡术中关节周围麻醉的患者同时进行双侧TKA。接受106次TKA的53名患者在随机选择的一个膝关节中接受了术中关节周围注射，其中添加了吗啡（0.1 mg/kg），另一个膝关节未添加吗啡。关节周围注射由罗哌卡因（局部麻醉剂）、肾上腺素、酮洛芬和甲泼尼龙钠组成。比较两膝关节在休息和活动时的视觉模拟量表疼痛评分、活动范围（ROM）、大腿肿胀、西安大略大学和麦克马斯特大学骨关节炎指数评分以及不良结局。在视觉模拟量表评分、ROM、大腿围度、西安大略和麦克马斯特大学骨关节炎指数评分方面没有统计学显著差异，结论：关节周围注射加用吗啡对局部止痛、消肿、改善术后ROM无效。（C）2017 Elsevier Inc. All rights reserved.
Background: The periarticular multimodal cocktail injection including morphine is currently commonly used to reduce postoperative pain following total knee arthroplasty (TKA). Despite its analgesic effect, it frequently causes nausea, which is an adverse effect of opioids. It is inconclusive whether the intra-operative injection of periarticular morphine is effective peripherally. The aim of this study was to assess whether the addition of morphine to unilateral periarticular knee injections improves postoperative pain, range of motion, and swelling in patients undergoing simultaneous bilateral TKA.Methods: A prospective, single-center, double-blinded, randomized, controlled trial was conducted to assess the local efficacy of adding morphine to intraoperative periarticular anesthesia in patients undergoing simultaneous bilateral TKA. Fifty-three patients undergoing 106 TKAs received an intraoperative periarticular injection in randomly selected one knee with added morphine (0.1 mg/kg) and the other knee without added morphine. The periarticular injection was composed of ropivacaine (a local anesthetic), epinephrine, ketoprofen, and methylprednisolone sodium. Visual analog scale pain scores at rest and on motion, range of motion (ROM), thigh swelling, the Western Ontario and McMaster Universities Osteoarthritis Index score, and adverse outcomes were compared between the 2 knees.Results: There were no statistically significant differences in the visual analog scale score, ROM, thigh girth, Western Ontario and McMaster Universities Osteoarthritis Index score, and adverse events between the 2 sides.Conclusion: Adding morphine to periarticular injections is ineffective locally for relieving pain, reducing swelling, and improving the postoperative ROM. (C) 2017 Elsevier Inc. All rights reserved.