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題名 | Is Total Knee Replacement More Painful Than Total Hip Replacement﹖=全膝關節及全髖關節置換術後病患疼痛程度有差異嗎﹖ |
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作者姓名(中文) | 龐維伍; 許德宗; 童健瓊; 洪志鵬; 張大鵬; 黃明和; | 書刊名 | 麻醉學雜誌 |
卷期 | 38:3 2000.09[民89.09] |
頁次 | 頁143-148 |
分類號 | 418.224 |
關鍵詞 | 自控式止痛器; 嗎啡; 疼痛; 髖膝關節置換術; Analgesia: patient-controlled; Morphine; Pain; Arthroplasty; Replacement: hip and knee; |
語文 | 英文(English) |
中文摘要 | 背景:於有效之止痛時,自控式止痛器(PCA)可以客觀的告知嗎啡用量,由此嗎啡用量進而瞭解其疼痛的程度。本研究的目的是要以嗎啡的用量來比較全髌關節及全膝關節置換術後病患疼痛程度的差異。方法:50位成人(24全髌關節,26全膝關節)以全身吸入麻醉變盲之方式作全關節置換術,當病人在恢復室開始感覺疼痛時,我們靜脈注射負荷量(loading dose)的嗎啡,使其VAS≦3。然後以自控式止痛器(PCA)給予嗎啡(1mg/mL)止痛并追蹤48小時,我們記錄疼痛分數(pain score)、總使用量(total dose)、需求次數(demand)、實得次數(delivery)、及副作用(adverse effect)。結果:兩組48小時追蹤之疼痛分數無差异。全膝關節後嗎啡止痛劑的用量比全髋關節多(P<0.05)。兩組48小時追蹤之副作用無差异。結論:全膝關節術後比全髋關節術後要痛并且嗎啡止痛劑的用量比較多,雖然詳細機轉并不明瞭,但是本文提出一些假說以供說明。 |
英文摘要 | Background: During its use in pain management the patient-controlled analgesia (PCA) devices are capable of registering the course of treatment at patient request, the condition of drug delivery and total amount of drug being given. The patients could determine the need of medication to their own satisfaction while forced treatment by the bias of the health care personnel is avoided and the safety of patients is further warranted. In pain relief with this device, the number of requests for analgesia and the dose of analgesic used can be easily measured. Therefore, it is more objective to compare the pain intensity among different types of operation when PCA device is used. Using PCA morphine consumption as a parametei; we attempted to elucidate the difference of intensity of pain associated with total hip and total knee replacements by comparing their morphine requirement. Methods: In this prospective cohort study, 50 patients who underwent either total hip replacement (THR, n=24) or total knee replacement (TKR, n=26) were enrolled. After recovery from general anesthesia when the patients first complained intense pain in the recovery room, morphine was given intravenously in titration with a calculated loading dose in 30 min to achieve an acceptable analgesia WAS 3) followed by morphine PCA at 1 mg bolus with a lockout interval of 6 mm. The patients were then followed for 48 h. During and at the end of the course the data relevant to pain score, total dose, demand, delivery, and adverse effects were recorded for assessment. Results: With the use of PCA, the pain scores were similar in both surgical groups in the 48 h observation. Total consumption of morphine in THR was 13.2 ± 8.1 nig as against 19.7 ± 5.7 mg in TKR in postoperative day 1 and 25.2 ± 12.7 mg as against 34.1 ± 13.9 mg in postoperative day 2 (P<0.05, t-test). Demand/delivery ratio was not statistic ally significant between the 2 groups at 24 and 48 h (t-test). Minor adverse effects were seen in both groups but the differences were not significant. Conclusions: Using PCA morphine consumption as parameter; we can distinguish the magnitude of pain intensity between 2 major orthopedic surgeries. The deeper and more extensive operation wound in total hip replacement does not mean that it is a more painful procedure than total knee replacement. Several speculations are proposed. |
本系統之摘要資訊系依該期刊論文摘要之資訊為主。