ObjectiveA prospective randomized controlled study was conducted to investigate the early postoperative analgesic effectiveness of using liposomal bupivacaine (LB) for local infiltration anesthesia (LIA) in unicompartmental knee arthroplasty (UKA). Methods Between January 2024 and July 2024, a total of 80 patients with knee osteoarthritis (KOA) who met the selection criteria were enrolled in the study. Patients were randomly assigned to either the LB group or the “cocktail” group in a 1∶1 ratio using a random number table, with 40 patients in each group. Baseline characteristics, including gender, age, body mass index, operated side, Kellgren-Lawrence grade, and preoperative American Society of Anesthesiologists (ASA) classification, Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) score, and knee joint range of motion, showed no significant difference between the two groups (P>0.05). Both groups received LIA and comprehensive pain management. The surgical duration, incision length, pain-related indicators [resting and activity visual analogue scale (VAS) scores, total dosage of oral morphine, WOMAC scores], knee joint range of motion, first ambulation time after operation, length of hospital stay, and postoperative adverse events. ResultsThere was no significant difference between the two groups in surgical duration, incision length, first ambulation time after operation, length of hospital stay, total dosage of oral morphine, and pre-discharge satisfaction with surgery and WOMAC scores (P>0.05). At 4, 12, and 24 hours after operation, the resting and activity VAS scores in the “cocktail” group were lower than those in the LB group; at 60 and 72 hours postoperatively, the resting VAS scores in the LB group were lower than those in the “cocktail” group, with the activity VAS scores also being lower at 60 hours; all showing significant differences (P<0.05). There was no significant difference in the above indicators between the two groups at other time points (P>0.05). On the second postoperative day, the sleep scores of the LB group were significantly higher than those of the “cocktail” group (P<0.05), while there was no significant difference in sleep scores on the day of surgery and the first postoperative day (P>0.05). Additionally, the incidence of complications showed no significant difference between the two groups (P>0.05). ConclusionThe use of LB for LIA in UKA can provide prolonged postoperative pain relief; however, it does not demonstrate a significant advantage over the “cocktail” method in terms of short-term analgesic effects or reducing opioid consumption and early functional recovery after UKA. Nevertheless, LB may help reduce postoperative sleep disturbances, making it a recommended option for UKA patients with cardiovascular diseases and insomnia or other mental health issues.
目的:探讨术后镇痛安全有效的用药最佳途径。方法:将我科住院需手术治疗的90例肝胆疾病患者随机分成3组,在术后采用不同的镇痛给药途径,Ⅰ组为肌肉注射、Ⅱ组为自控硬膜外镇痛(PCEA)、Ⅲ组为微量输液泵。分别于术后6 h、24 h、48 h采用视觉模拟评分法(VAS)观察镇痛效果和不良反应等指标。 结果:Ⅱ组自控硬膜外镇痛(PCEA)和Ⅲ组微量输液泵镇痛效果明显优于Ⅰ组肌肉注射(Plt;001),Ⅱ组自控硬膜外镇痛(PCEA)组并发症多于Ⅰ组肌肉注射和Ⅲ组微量输液泵(Plt;001)。结论:3种不同镇痛给药途径用于术后患者,经临床实践研究,其最佳给药途径为微量输液泵,因易操作、安全、不良反应少、可根据疼痛的程度及时调节有效剂量,患者易接受,是一种经济实用科学的镇痛方法。
ObjectiveTo explore the analgesic effect of local infiltration anesthesia with liposome bupivacaine (LB) after Milligan-Morgan hemorrhoidectomy through a multicenter, double-blind, randomized controlled study. MethodsA prospective study was conducted on 240 patients with mixed hemorrhoids admitted to the Third Affiliated Hospital of Henan University of Traditional Chinese Medicine, Henan Province Hospital of Traditional Chinese Medicine, Zhengzhou Hospital for Largeintestinal and Anal Diseases, and Puyang People’s Hospital between December 2023 and June 2024. Patients were randomly divided into an observation group (receiving liposome bupivacaine injection) and a control group (receiving methylene blue injection) using a random number table. Postoperative outcomes including pain (VAS) scores, insomnia scores, postoperative edema, urination, time to first defecation, pain during first defecation, perianal sensory recovery time, hospital stay, need for additional analgesic medication, and postoperative complications were compared between the two groups. ResultsAmong 240 patients, 238 completed the study and were included in the analysis, with 119 patients in the observation group and 119 in the control group.① There were no statistically significant differences in baseline characteristics between the two groups (P>0.05).② Postoperative anal pain scores at 6 h, 12 h, 24 h, 48 h, 72 h, and 5 days were lower in the observation group than in the control group (P<0.05).③ Postoperative insomnia scores on days 1, 2, 3, and 5 were lower in the observation group compared with the control group (P<0.05).④ Postoperative edema scores on days 3, 5, and 7 were lower in the observation group than in the control group (P<0.001).⑤ The observation group showed superior outcomes compared to the control group in the following parameters: postoperative 24-hour urination score [0 points vs. 0 points, Z=–2.528, P=0.011]、time to first defecation [2 days vs. 2 days, Z=–2.638, P=0.008]、pain score at first defecation [3 points vs. 5 points, Z=–2.528, P<0.001]、time to recovery of perianal sensation [2 days vs. 1 day, Z=–4.977, P<0.001]、hospital stay duration [6 days vs. 11 days, Z=–12.170, P<0.001]、supplemental analgesic medication need at 7 days postoperation [20.1% vs. 80.7%, χ2 = 87.132, P<0.001]. No statistically significant differences were observed between the two groups in the incidence of complications such as:postoperative nausea [6.7% vs. 8.4%, χ2 = 0.240, P=0.624]、vomiting [5.0% vs. 7.6%, χ2 = 0.640, P=0.424]、dizziness [1.7% vs. 4.2%, χ2=1.325, P=0.250]. ConclusionsLocal infiltration anesthesia with LB after Milligan-Morgan hemorrhoidectomy significantly reduces postoperative pain, insomnia, and edema, shortens hospital stays, and accelerates postoperative recovery. LB demonstrates broad clinical application potential.