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Background: Postoperative continuous intravenous analgesia may not provide effective postoperative analgesia following total knee arthroplasty. This study was conducted to determine if combined continuous intravenous analgesia and peri-articular infiltration provided a better quality of analgesia following total knee arthroplasty than epidural analgesia.
Methods: A prospective, double-blind study involving 50 patients who had undergone total knee arthroplasty was conducted. Patients were divided into control group and an experimental group. Patients in the control group (n = 25) received peri-articular infiltration with 47 mL normal saline prior to closure of the wound and postoperative epidural analgesia for 48 hours. Patients in the experimental group (n = 25) received a mixture of peri-articular infiltration of 16 mL of 0.75% ropivacaine, 6 mg morphine, 0.2 mg of epinephrine and 25 mL normal saline prior to closure of the wound and postoperative continuous intravenous analgesia for 48 hours. The analgesic efficacy was then evaluated using the verbal numeric rating scale at 1, 2, 6, 12, 24, and 48 hours postoperatively. The side effects and the dosage of rescue analgesics were then recorded.
Results: The experimental group showed a significantly higher pain score than the control group 2 and, 6 hours postoperatively at rest and 2 hours postoperatively following passive knee movement (P ＜ 0.05). In addition, the rescue analgesic requirement was higher for the experimental group during the first 24 hours following surgery than for the control group (P ＜ 0.05).
Conclusions: We found that combined continuous intravenous analgesia and peri-articular infiltration of a mixture of ropivacaine and, morphine injected into the peri-articular tissue provided minimal benefits for pain control during the early postoperative period when compared to epidural analgesia after total knee arthroplasty.권호기사
참고문헌 (29건) : 자료제공( 네이버학술정보 )
| 번호 | 참고문헌 | 국회도서관 소장유무 |
|---|---|---|
| 1 | Comparison of Three Diffferent Modalities for Combined Spinal Epidural Anesthesia and Spinal Anesthesia in Geriatric Patients | 소장 |
| 2 | Epidural haematoma after a combined spinal-epidural anaesthetic in a patient treated with clopidogrel and dalteparin.  |
미소장 |
| 3 | Anticoagulation and Neuraxial Block |
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| 4 | Anticoagulants and spinal-epidural anesthesia. |
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| 5 | Stein C, Millan MJ, Shippenberg TS, Peter K, Herz A: Peripheral opioid receptors mediating antinociception in inflammation. Evidence for involvement of mu, delta and kappa receptors. J Pharmacol Exp Ther 1989; 248: 1269-75. | 미소장 |
| 6 | Severe neurological complications after central neuraxial blockades in Sweden 1990-1999. |
미소장 |
| 7 | A Multimodal Analgesia Protocol for Total Knee Arthroplasty |
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| 8 | Choi HG, Kim SG, Kwon SB, Kim JS, Kwon HU, Kang PS: The analgesic effect of postoperative combined epidural, soft tissue, and intra-articular injection of morphine and bupivacaine in patients undergoing total knee arthroplasty. Korean J Anesthesiol 2006; 50: 546-51. | 미소장 |
| 9 | The efficacy of intra-articular analgesia after total knee arthroplasty in patients with rheumatoid arthritis and in patients with osteoarthritis |
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| 10 | Klasen JA, Opitz SA, Melzer C, Thiel A, Hempelmann G: Intraarticular, epidural, and intravenous analgesia after total knee arthroplasty. Acta Anaesthesiol Scand 1999; 43: 1021-6. | 미소장 |
| 11 | The Effects of Intra synovial Ropivacaine and Morphine Injection on Postoperative Pain After Total Knee Arthroplasty |
미소장 |
| 12 | Intra-articular morphine and/or bupivacaine in the management of pain after total knee arthroplasty |
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| 13 | Controlling Pain After Total Hip and Knee Arthroplasty Using a Multimodal Protocol With Local Periarticular Injections: A Prospective Randomized Study |
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| 14 | A Randomized Trial of a Multicomponent Home Intervention to Reduce Functional Difficulties in Older Adults |
미소장 |
| 15 | The Role of Intrathecal Drugs in the Treatment of Acute Pain |
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| 16 | Comparison of Bupivacaine-and Ropivacaine-Induced Conduction Blockade in the Isolated Rabbit Vagus Nerve |
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| 17 | Differences in cardiotoxicity of bupivacaine and ropivacaine are the result of physicochemical and stereoselective properties. |
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| 18 | Cardiac electrophysiologic properties of bupivacaine and lidocaine compared with those of ropivacaine, a new amide local anesthetic. |
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| 19 | Bartho L, Stein C, Herz A: Involvement of capsaicin-sensitive neurones in hyperalgesia and enhanced opioid antinociception in inflammation. Naunyn Schmiedebergs Arch Pharmacol 1990; 342: 666-70. | 미소장 |
| 20 | Lawrence AJ, Joshi GP, Michalkiewicz A, Blunnie WP, Moriarty DC: Evidence for analgesia mediated by peripheral opioid receptors in inflamed synovial tissue. Eur J Clin Pharmacol 1992; 43: 351-5. | 미소장 |
| 21 | Opiates inhibit the discharges of fine afferent units from inflamed knee joint of the cat |
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| 22 | Peripheral Mechanisms of Opioid Analgesia |
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| 23 | Local analgesic effect of endogenous opioid peptides |
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| 24 | Opioids from Immunocytes Interact with Receptors on Sensory nerves to Inhibit Nociception in Inflammation |
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| 25 | Yaksh TL: Substance P release from knee joint afferent terminals: modulation by opioids. Brain Res 1988; 458: 319-24. | 미소장 |
| 26 | Lombardi AV Jr, Berend KR, Mallory TH, Dodds KL, Adams JB: Soft tissue and intra-articular injection of bupivacaine, epinephrine, and morphine has a beneficial effect after total knee arthroplasty. Clin Orthop Relat Res 2004; 428: 125-30. | 미소장 |
| 27 | Postoperative Pain Following Knee Arthroscopy |
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| 28 | Recent intraarticular steroid injection may increase infection rates in primary THA. |
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| 29 | Septic arthritis of the hip following cortisone injection: Case report and review of the literature |
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