布比卡因脂质体在全膝关节置换术后的镇痛疗效

doi:10.6040/j.issn.1671-7554.0.2025.1106

摘要/Abstract

摘要： 目的旨在比较布比卡因脂质体与传统“鸡尾酒”关节周围注射在全膝关节置换术患者中的镇痛效果。方法选取2024年4月至2024年9月在我院行单侧全膝关节置换术的患者60例,其中男28例,女32例,53~83岁,平均68.15岁。患者随机分为布比卡因脂质体注射组(n=32)和传统“鸡尾酒”注射组(n=28)。采用视觉模拟评分法(visual analogue scale, VAS)观察术后24、48、72 h患者活动和静息状态下的疼痛强度,次要观察指标包括术后72 h关节活动度(range of motion, ROM)、出院时的西安大略和麦克马斯特大学骨关节炎指数(Western Ontarioand McMaster Universities Osteoarthritis Index, WOMAC)评分、患者首次使用自控镇痛的时间、抬腿时间、下床时间、术后恶心发生率、术后出血情况及曲马多服用频率。结果布比卡因脂质体注射组患者在术后24(P=0.04)、48(P=0.02)、72 h(P=0.02)活动状态下的疼痛评分显著低于传统“鸡尾酒”注射组。两组在静息状态下疼痛评分、ROM、WOMAC评分、自控镇痛时间、抬腿时间、下床活动时间、术后恶心发生率、术后出血情况及曲马多服用频率方面差异无统计学意义(P>0.05)。结论布比卡因脂质体在TKA术后活动状态下的镇痛效果优于传统“鸡尾酒”,但对静息痛及其他次要观察指标无显著影响,提示其在TKA多模式镇痛策略中具有应用潜力。

关键词: 布比卡因脂质体, 全膝关节置换术, 关节周围注射, 多模式镇痛, 疼痛管理

Abstract: Objective To compare the analgesic efficacy of liposomal bupivacaine with that of a traditional periarticular injection(TPAI)in patients undergoing total knee arthroplasty(TKA). Methods A total of 60 patients(28 males and 32 females, aged 53-83 years, with a mean age of 68.15 years)who were scheduled to undergo unilateral TKA between April and September 2024 were enrolled in this study. The patients were randomly assigned to either the liposomal bupivacaine group or the TPAI group. The primary outcome was pain intensity, which was assessed by the visual analogue scale(VAS)during activity and at rest at 24, 48, and 72 hours postoperatively. Secondary outcomes included the range of motion(ROM)at 72 hours, Western Ontario and McMaster Universities Osteoarthritis Index(WOMAC)score at discharge, the time to first use of patient-controlled analgesia(PCA), time to leg lift and ambulation, incidence of postoperative nausea and bleeding, and frequency of tramadol consumption. Results The resuts showed that the liposomal bupivacaine group had significantly lower pain scores during activity at 24(P=0.04), 48(P=0.02), and 72(P=0.02)hours postoperatively compared to the TPAI group. There were no statistically significant differences between the two groups in pain scores at rest, ROM, WOMAC scores, time to first PCA use, time to leg lift, time to ambulation, incidence of postoperative nausea or bleeding, or frequency of tramadol consumption(P>0.05). Conclusion Liposomal bupivacaine provides superior analgesia during activity compared to the TPAI after total knee arthroplasty(TKA), although it shows no significant advantage for pain at rest or on other secondary outcomes. These findings suggest its potential role in multimodal analgesia strategies for TKA.

Key words: Liposomal bupivacaine, Total knee arthroplasty, Periarticular injection, Multimodal analgesia, Pain management

中图分类号:

R614

宋轲,牟宗友,翟申浩,牛闯,郭亚琪,张腾腾,任雪冰,刘培来. 布比卡因脂质体在全膝关节置换术后的镇痛疗效[J]. 山东大学学报 (医学版), 2026, 64(2): 111-117.

SONG Ke, MU Zongyou, ZHAI Shenhao, NIU Chuang, GUO Yaqi, ZHANG Tengteng, REN Xuebing, LIU Peilai. Analgesic effect of bupivacaine liposome after total knee arthroplasty[J]. Journal of Shandong University (Health Sciences), 2026, 64(2): 111-117.

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