アメリカの薬物送達と治療学ジャーナル オープンアクセス

抽象的な

選択的初回股関節・膝関節置換術後の効果的な疼痛緩和のための局所浸潤麻酔（LIA）と新しい技術 - 革新的な研究

モハメド・サルハブ

背景： 

選択的全膝関節置換術 (TKR) および全股関節置換術 (THR) 後の急性疼痛管理は、通常不十分であり、長期慢性疼痛障害と関連しています。中等度から重度の疼痛は、通常、術後最初の 48 時間に報告され、持続的管理鎮痛やマルチモーダル鎮痛などのさまざまな疼痛管理方法を必要とします。局所浸潤麻酔 (LIA) 法は、現在、術中の疼痛管理に確立された方法ですが、これまでの研究では相反する証拠が報告されています。TKR での LIA の使用を調査した 29 件の研究の最近の調査では、LIA は疼痛管理が改善された安全な方法として確立されました (Gibbs DMR 2012)。私たちは、術後に持続的に新規混合物 (NM) を注入できる関節内カテーテルを組み込んだ LIA 法を開発しました。予防的鎮痛は鎮痛治療であり、手術前に開始する治療で、手術中に生じる切創や火傷によって引き起こされる痛みの激化を予防します。手術前の治療に加え、予防的鎮痛は術後早期に使用できます。この防御効果は、予防的鎮痛が侵害受容系に与えるものです。痛みの感覚を阻害するために、本論文では薬物療法や治療を含むいくつかの方法を紹介しています。

Joint substitution medical procedures are considered as one of the most excruciating orthopedic techniques. This excruciating method is the aftereffect of lacking and inadequately rewarded postoperative torment after significant joint substitution medical procedure. This agony scene must be ideal tended to in light of the fact that not exclusively does this fundamentally drag out the restoration procedure, yet in addition purposes the expanded danger of different inconveniences. If not tended to inside time or without legitimate methodology, these postoperative excruciating scenes can advance into constant torment, which in the long run drags out the general length of hospitalization and cost. The excursion to accomplish the total and long haul help with discomfort starts before the medical procedure is performed. A significant premise to accomplish long haul help with discomfort and practical recuperation after the joint medical procedure includes adequate peri-employable absense of pain. One of the significant angles to accomplish effective result after joint medical procedure is the early joint preparation with the commencement of non-intrusive treatment. A few new medications and novel procedures to enhance the post-employable agony post-medical procedure are being presented each year, yet the greater part of the patients despite everything wind up experiencing extraordinary torment following medical procedure which frequently advances into constant torment.

Arthroscopic knee medical procedure has gotten progressively well known in present day orthopedics. In any case, the post-employable knee torment the board including early help and agony free postoperative consideration to the patient stays a test to a few clinicians. Now and again, torment the board in itself has become a need for the board as a childcare methodology. Tenacious agony after knee arthoplasty stays an uncertain issue for some patients. Torment is considered as an exceptionally emotional occasion since everybody has an alternate recognition and edge of agony. What's more, hence, it turns out to be hard to normalize any agony system for a specific medical procedure. A few factors that cause knee torment, which incorporate aggravation of free sensitive spots of the joint case, synovial tissue, front fat cushion.

The point of neighborhood penetration is to anesthetize sensitive spots in a limited territory of tissue by the infusion of neighborhood sedatives close by. This stands as opposed to fringe nerve obstructs, in which nerve axons are the objective and the infusion may occur in a region expelled from the careful site (eg, brachial plexus hinder for hand medical procedure). The profundity of the region to be worked on commonly decides the necessary degree of invasion. For shallow skin methods, for example, stitching of slashes and skin biopsies, subcutaneous or intradermal penetration is adequate. Increasingly broad tasks may request invasion into muscle, belt, and other profound tissues. Two general methodologies exist for anesthetizing skin and subcutaneous tissue. The first includes infusing neighborhood sedative legitimately into the line of cut and close by tissues, successfully flooding the individual nearby sensitive spots to deliver sedation. This can be exceptionally successful, yet may require huge volumes of neighborhood sedative to accomplish total inclusion.

Aims and Objectives:

In this study we find out the results on our experience using LIA in addition to the Novel Techniques and Proprietary NM developed in Leeds-Bradford and infiltrated at 4-5 mls/hour for 48 hours post surgery.

Materials and Methods:

Between October 2013 and October 2015, 62 patients undergoing primary TKR were prospectively followed up. Three groups of patients were studied. All patients studied had spinal anaesthesia (SA) with 300-400mcg diamorphine.

Group 1.  GA. No LIA and no NM. 20 patients.

Group 2.   SA plus NM for 48 hours post operatively with catheter placed anteriorly under the patella.  21 patients.

Group 3.  SA plus LIA plus NM for 48 hours post operatively with catheter placed posteriorly in the knee joint.  21 patients.

Between June 2011 and July 2014, 173 consecutive patients undergoing primary THR using the posterior approach were also prospectively followed up.

Results and complications: 

The patients without LIA or NM required more morphine in the initial 12 hours postoperative period than different gatherings. 70% (n=14) of these gathering 1 patients required 10mg morphine following TKR contrasted with just 2% (n=1) of patients requiring 10mg of morphine when LIA and NM were utilized. The expanded morphine necessity proceeded for 48 hours postoperatively in bunch 1, while none of the patients in bunches 2 or 3 required morphine following 36 hours. Factual investigation uncovered no distinction of morphine necessities with various catheter situation. Less patients experienced sickness and heaving or urinary maintenance in the gathering with LIA and NM (p-esteem <0.05, Mann-Whitney test). There were no contaminations DVT or different difficulties in any of the gatherings.

Conclusion:

この研究は、TKR 後の患者が LIA と NM で 48 時間治療した場合、この期間中にモルヒネの使用量が大幅に減少したことを示しています。この利点は、通常、手術後の最初の 24 時間に現れ、48 時間持続しました。LIA と NM を使用した場合、他のグループと比較して鎮痛剤による鎮痛を必要とした患者は少なかったです。最も高い集中度は、モルヒネ使用量が 20 mg までの患者では 0～12 時間 (χ2(2) = 46.713、p = 0.000)、モルヒネ使用量が 30 mg の患者では 0～12 時間 (χ2(2) = 46.310、p = 0.000) でした。