氢吗啡酮复合罗哌卡因膝关节腔内注射用于膝关节镜术后镇痛的观察*

Observation of intra-articular Hydromorphone with Ropivacaine for analgesia after knee arthroscopy*

摘要:

目的??观察氢吗啡酮复合罗哌卡因膝关节腔内注射用于膝关节镜手术患者的术后镇痛效果。方法?90例行膝关节镜手术患者，随机分为3组：膝关节腔内注射0.375%罗哌卡因20 ml（R组）；氢吗啡酮0.3 mg+0.375%罗哌卡因20 ml（H1组）；氢吗啡酮0.6 mg+0.375%罗哌卡因20 ml（H2组）。观察术后6、12、18和24 h患者静态视觉模拟评分法（VAS）评分，术后镇痛持续时间、术后24 h使用帕瑞昔布的患者例数及次数。结果?与R组相比，术后12和18 h，H1组和H2组VAS评分降低，术后镇痛持续时间明显延长，术后24 h使用帕瑞昔布的患者例数及次数明显减少（P <0.05）；H1组与H2组VAS评分、术后镇痛持续时间、使用帕瑞昔布的患者例数及次数差异无统计学意义（P >0.05）。结论?膝关节镜术后，关节腔内注入0.3 mg氢吗啡酮可明显增强罗哌卡因的镇痛效果，且增加氢吗啡酮剂量不再增强镇痛效果。

Abstract:

Objective?To assess the effects of intra-articular Hydromorphone with Ropivacaine for postoperative analgesia after arthroscopic knee surgery.?Methods?90 patients undergoing arthroscopic knee surgery were randomly divided into 3 groups. Group R: 0.375% Ropivacaine 20ml; group H1: Hydromorphone 0.3 mg and 0.375 % Ropivacaine 20 ml; group H2: Hydromorphone 0.6 mg and 0.375 % Ropivacaine 20 ml. The visual analogue scale (VAS) at rest were recorded at 6, 12, 18 and 24 h after surgery, Duration of analgesia, number of patients and frequency requiring Parecoxib at 24 h after surgery were observed.?Results?Compared with group R, VAS of group H1 and group H2 were significantly lower at 12 and 18h after the operation, duration of analgesia was much longer, number of patients and frequency requiring Parecoxib was lower in group H1 and H2 (P < 0.05); Compared with group H1, No significant differences of VAS, duration of analgesia and number of patients and frequency requiring Parecoxib of group H2.?Conclusions?After knee arthroscopic surgery, intra-articular 0.3 mg Hydromorphone can significantly improve the efficacy of Ropivacaine for postoperative analgesia; the efficacy of Hydromorphone can’t increased with the increase of dosage.