Journal of Translational Medical Research
تحقیقات پزشکی ترجمانی
J Transl Med Res.
Medical Sciences
http://journal.bums.ac.ir
87
journal87
3115-9176
3092-6912
10.61882/JBUMS
fa
jalali
1399
9
1
gregorian
2020
12
1
27
4
online
1
fulltext
fa
بررسی تزریق داخل مفصلی بوپیواکائین با مورفین یا متیل پردنیزولون یا به تنهایی بر درد بعد از عمل آرتروسکوپی
Evaluation of intra-articular injection of bupivacaine in combination with morphine, methylprednisolone, or alone on pain after knee arthroscopy
بيهوشي
Anesthesiology
مقاله اصیل پژوهشی
Original Article
<div style="text-align: justify;"><strong><span style="font-family:B Mitra;"><span style="font-size:10.0pt;">زمینه و هدف:</span></span></strong><span style="font-family:B Mitra;"><span style="font-size:11.0pt;"> آرتروسکوپی</span></span> <span style="font-family:B Mitra;"><span style="font-size:11.0pt;">زانو</span></span> <span style="font-family:B Mitra;"><span style="font-size:11.0pt;">برای</span></span> <span style="font-family:B Mitra;"><span style="font-size:11.0pt;">تشخیص</span></span> <span style="font-family:B Mitra;"><span style="font-size:11.0pt;">و</span></span> <span style="font-family:B Mitra;"><span style="font-size:11.0pt;">درمان</span></span> <span style="font-family:B Mitra;"><span style="font-size:11.0pt;">ضایعات</span></span> <span style="font-family:B Mitra;"><span style="font-size:11.0pt;">داخل</span></span> <span style="font-family:B Mitra;"><span style="font-size:11.0pt;">مفصلی</span></span> <span style="font-family:B Mitra;"><span style="font-size:11.0pt;">کاربرد</span></span> <span style="font-family:B Mitra;"><span style="font-size:11.0pt;">دارد. کنترل</span></span> <span style="font-family:B Mitra;"><span style="font-size:11.0pt;">درد</span></span> <span style="font-family:B Mitra;"><span style="font-size:11.0pt;">حاد</span></span> <span style="font-family:B Mitra;"><span style="font-size:11.0pt;">بعد</span></span> <span style="font-family:B Mitra;"><span style="font-size:11.0pt;">از</span></span> <span style="font-family:B Mitra;"><span style="font-size:11.0pt;">آرتروسکوپی</span></span> <span style="font-family:B Mitra;"><span style="font-size:11.0pt;">نیازمند</span></span> <span style="font-family:B Mitra;"><span style="font-size:11.0pt;">بهکارگیری</span></span> <span style="font-family:B Mitra;"><span style="font-size:11.0pt;">روشی</span></span> <span style="font-family:B Mitra;"><span style="font-size:11.0pt;">با</span></span> <span style="font-family:B Mitra;"><span style="font-size:11.0pt;">کمترین</span></span> <span style="font-family:B Mitra;"><span style="font-size:11.0pt;">عوارض</span></span> <span style="font-family:B Mitra;"><span style="font-size:11.0pt;">جانبی</span></span> <span style="font-family:B Mitra;"><span style="font-size:11.0pt;">و</span></span> <span style="font-family:B Mitra;"><span style="font-size:11.0pt;">بیشترین</span></span> <span style="font-family:B Mitra;"><span style="font-size:11.0pt;">کارآیی</span></span> <span style="font-family:B Mitra;"><span style="font-size:11.0pt;">میباشد. هدف</span></span> <span style="font-family:B Mitra;"><span style="font-size:11.0pt;">از</span></span> <span style="font-family:B Mitra;"><span style="font-size:11.0pt;">این</span></span> <span style="font-family:B Mitra;"><span style="font-size:11.0pt;">مطالعه</span></span> <span style="font-family:B Mitra;"><span style="font-size:11.0pt;">مقایسه</span></span> <span style="font-family:B Mitra;"><span style="font-size:11.0pt;">اثر</span></span> <span style="font-family:B Mitra;"><span style="font-size:11.0pt;">تس</span></span><span style="font-family:B Mitra;"><span style="font-size:11.0pt;">کینی</span></span><span style="font-family:B Mitra;"><span style="font-size:11.0pt;"> پس</span></span> <span style="font-family:B Mitra;"><span style="font-size:11.0pt;">از</span></span> <span style="font-family:B Mitra;"><span style="font-size:11.0pt;">عمل</span></span> <span style="font-family:B Mitra;"><span style="font-size:11.0pt;">تزریق</span></span> <span style="font-family:B Mitra;"><span style="font-size:11.0pt;">داخل</span></span> <span style="font-family:B Mitra;"><span style="font-size:11.0pt;">مفصلی</span></span> <span style="font-family:B Mitra;"><span style="font-size:11.0pt;">ترکیب بوپیواکایین با</span></span> <span style="font-family:B Mitra;"><span style="font-size:11.0pt;">مرفین</span></span> <span style="font-family:B Mitra;"><span style="font-size:11.0pt;">یا متیل</span></span> <span style="font-family:B Mitra;"><span style="font-size:11.0pt;">پردنیزولون یا</span></span> <span style="font-family:B Mitra;"><span style="font-size:11.0pt;">به تنهایی در</span></span> <span style="font-family:B Mitra;"><span style="font-size:11.0pt;">آرتروسکوپی</span></span> <span style="font-family:B Mitra;"><span style="font-size:11.0pt;">زانو</span></span> <span style="font-family:B Mitra;"><span style="font-size:11.0pt;">بود</span></span><span style="font-family:B Mitra;"><span style="font-size:11.0pt;">.</span></span><span style="font-family:B Mitra;"><span style="font-size:11.0pt;"></span></span><br>
<strong><span style="font-family:B Mitra;"><span style="font-size:10.0pt;">روش تحقیق:</span></span></strong><span style="font-family:B Mitra;"><span style="font-size:11.0pt;"> در</span></span> <span style="font-family:B Mitra;"><span style="font-size:11.0pt;">این</span></span> <span style="font-family:B Mitra;"><span style="font-size:11.0pt;">مطالعه</span></span> <span style="font-family:B Mitra;"><span style="font-size:11.0pt;">کار</span></span> <span style="font-family:B Mitra;"><span style="font-size:11.0pt;">آزمایی</span></span> <span style="font-family:B Mitra;"><span style="font-size:11.0pt;">بالینی سه سوکور</span></span><span style="font-family:B Mitra;"><span style="font-size:11.0pt;">، </span></span><span style="font-family:B Mitra;"><span style="font-size:11.0pt;">99</span></span> <span style="font-family:B Mitra;"><span style="font-size:11.0pt;">بیمار</span></span> <span style="font-family:B Mitra;"><span style="font-size:11.0pt;">داوطلب</span></span> <span style="font-family:B Mitra;"><span style="font-size:11.0pt;">آرتروسکوپی</span></span> <span style="font-family:B Mitra;"><span style="font-size:11.0pt;">زانو</span></span> <span style="font-family:B Mitra;"><span style="font-size:11.0pt;">به</span></span> <span style="font-family:B Mitra;"><span style="font-size:11.0pt;">صورت</span></span> <span style="font-family:B Mitra;"><span style="font-size:11.0pt;">تصادفی</span></span> <span style="font-family:B Mitra;"><span style="font-size:11.0pt;">به</span></span> <span style="font-family:B Mitra;"><span style="font-size:11.0pt;">سه</span></span> <span style="font-family:B Mitra;"><span style="font-size:11.0pt;">گروه: 1</span></span> <span style="font-family:B Mitra;"><span style="font-size:11.0pt;">کنترل بوپیواکایین (0/5درصد</span></span><span dir="LTR"><span style="font-size:9.0pt;"> (</span></span><span style="font-family:B Mitra;"><span style="font-size:11.0pt;">، 2.</span></span> <span style="font-family:B Mitra;"><span style="font-size:11.0pt;">مرفین (5</span></span> <span style="font-family:B Mitra;"><span style="font-size:11.0pt;">میلی</span></span> <span style="font-family:B Mitra;"><span style="font-size:11.0pt;">گرم)+</span></span> <span style="font-family:B Mitra;"><span style="font-size:11.0pt;">بوپیواکایین (0/5 درصد) 3. متیل</span></span> <span style="font-family:B Mitra;"><span style="font-size:11.0pt;">پردنیزولون (40</span></span> <span style="font-family:B Mitra;"><span style="font-size:11.0pt;">میلی</span></span> <span style="font-family:B Mitra;"><span style="font-size:11.0pt;">گرم)+ بوپیواکایین (</span></span><span style="font-family:B Mitra;"><span style="font-size:11.0pt;">0/5 درصد</span></span><span dir="LTR"><span style="font-size:9.0pt;">(</span></span><span style="font-family:B Mitra;"><span style="font-size:11.0pt;">،</span></span> <span style="font-family:B Mitra;"><span style="font-size:11.0pt;">تقسیم شدند. در</span></span> <span style="font-family:B Mitra;"><span style="font-size:11.0pt;">پایان</span></span> <span style="font-family:B Mitra;"><span style="font-size:11.0pt;">عمل</span></span> <span style="font-family:B Mitra;"><span style="font-size:11.0pt;">، </span></span><span style="font-family:B Mitra;"><span style="font-size:11.0pt;">داروهای</span></span> <span style="font-family:B Mitra;"><span style="font-size:11.0pt;">مورد</span></span> <span style="font-family:B Mitra;"><span style="font-size:11.0pt;">نظر</span></span> <span style="font-family:B Mitra;"><span style="font-size:11.0pt;">به صورت داخل</span></span> <span style="font-family:B Mitra;"><span style="font-size:11.0pt;">مفصلی</span></span> <span style="font-family:B Mitra;"><span style="font-size:11.0pt;">تزریق</span></span> <span style="font-family:B Mitra;"><span style="font-size:11.0pt;">و</span></span> <span style="font-family:B Mitra;"><span style="font-size:11.0pt;">میزان</span></span> <span style="font-family:B Mitra;"><span style="font-size:11.0pt;">درد</span></span> <span style="font-family:B Mitra;"><span style="font-size:11.0pt;">بعد</span></span> <span style="font-family:B Mitra;"><span style="font-size:11.0pt;">از</span></span> <span style="font-family:B Mitra;"><span style="font-size:11.0pt;">عمل در فواصل18،12،6و 24 ساعت</span></span> <span style="font-family:B Mitra;"><span style="font-size:11.0pt;">پس</span></span> <span style="font-family:B Mitra;"><span style="font-size:11.0pt;">از</span></span> <span style="font-family:B Mitra;"><span style="font-size:11.0pt;">تزریق</span></span> <span style="font-family:B Mitra;"><span style="font-size:11.0pt;">بر</span></span> <span style="font-family:B Mitra;"><span style="font-size:11.0pt;">اساس</span></span> <span style="font-family:B Mitra;"><span style="font-size:11.0pt;">مقیاس</span></span> <span style="font-family:B Mitra;"><span style="font-size:11.0pt;">آنالوگ</span></span> <span style="font-family:B Mitra;"><span style="font-size:11.0pt;">بصری</span></span> <span style="font-family:B Mitra;"><span style="font-size:11.0pt;">ارزیابی</span></span> <span style="font-family:B Mitra;"><span style="font-size:11.0pt;">شد. همچنین</span></span> <span style="font-family:B Mitra;"><span style="font-size:11.0pt;">دریافت</span></span> <span style="font-family:B Mitra;"><span style="font-size:11.0pt;">مسکن</span></span> <span style="font-family:B Mitra;"><span style="font-size:11.0pt;">تزریقی</span></span> <span style="font-family:B Mitra;"><span style="font-size:11.0pt;">در</span></span> <span style="font-family:B Mitra;"><span style="font-size:11.0pt;">طی</span></span> <span style="font-family:B Mitra;"><span style="font-size:11.0pt;">24</span></span> <span style="font-family:B Mitra;"><span style="font-size:11.0pt;">ساعت نیز</span></span> <span style="font-family:B Mitra;"><span style="font-size:11.0pt;">ثبت</span></span> <span style="font-family:B Mitra;"><span style="font-size:11.0pt;">گردید</span></span><span dir="LTR"><span style="font-size:9.0pt;">.</span></span><span style="font-family:B Mitra;"><span style="font-size:11.0pt;"> داده ها با استفاده از نرم افزار </span></span><span dir="LTR"><span style="font-size:9.0pt;">SPSS</span></span><span style="font-family:B Mitra;"><span style="font-size:11.0pt;"> و آزمونهای آنالیز واریانس اندازههای تکرار شونده تحلیل شدند</span></span><span style="font-family:B Mitra;"><span style="font-size:11.0pt;">.</span></span><span style="font-family:B Mitra;"><span style="font-size:11.0pt;"></span></span><br>
<strong><span style="font-family:B Mitra;"><span style="font-size:10.0pt;">یافتهها:</span></span></strong> <span style="font-family:B Mitra;"><span style="font-size:11.0pt;">در</span></span> <span style="font-family:B Mitra;"><span style="font-size:11.0pt;">هر</span></span> <span style="font-family:B Mitra;"><span style="font-size:11.0pt;">سه</span></span> <span style="font-family:B Mitra;"><span style="font-size:11.0pt;">گروه</span></span> <span style="font-family:B Mitra;"><span style="font-size:11.0pt;">با</span></span> <span style="font-family:B Mitra;"><span style="font-size:11.0pt;">گذشت</span></span> <span style="font-family:B Mitra;"><span style="font-size:11.0pt;">زمان</span></span> <span style="font-family:B Mitra;"><span style="font-size:11.0pt;">شدت</span></span> <span style="font-family:B Mitra;"><span style="font-size:11.0pt;">درد</span></span> <span style="font-family:B Mitra;"><span style="font-size:11.0pt;">به</span></span> <span style="font-family:B Mitra;"><span style="font-size:11.0pt;">طور</span></span> <span style="font-family:B Mitra;"><span style="font-size:11.0pt;">معنیداری</span></span> <span style="font-family:B Mitra;"><span style="font-size:11.0pt;">کاهش</span></span> <span style="font-family:B Mitra;"><span style="font-size:11.0pt;">پیدا</span></span> <span style="font-family:B Mitra;"><span style="font-size:11.0pt;">کرد. می</span></span><span style="font-family:B Mitra;"><span style="font-size:11.0pt;">زان</span></span><span style="font-family:B Mitra;"><span style="font-size:11.0pt;"> شدت</span></span> <span style="font-family:B Mitra;"><span style="font-size:11.0pt;">درد</span></span> <span style="font-family:B Mitra;"><span style="font-size:11.0pt;">در بازه های مختلف</span></span> <span style="font-family:B Mitra;"><span style="font-size:11.0pt;">پس</span></span> <span style="font-family:B Mitra;"><span style="font-size:11.0pt;">از</span></span> <span style="font-family:B Mitra;"><span style="font-size:11.0pt;">عمل،</span></span> <span style="font-family:B Mitra;"><span style="font-size:11.0pt;">در</span></span> <span style="font-family:B Mitra;"><span style="font-size:11.0pt;">دو گروه</span></span> <span style="font-family:B Mitra;"><span style="font-size:11.0pt;">متیل پردنیزولون + بوپیواکائین</span></span> <span style="font-family:B Mitra;"><span style="font-size:11.0pt;">و</span></span> <span style="font-family:B Mitra;"><span style="font-size:11.0pt;">گروه</span></span> <span style="font-family:B Mitra;"><span style="font-size:11.0pt;">مرفین+بوپیواکائین یکسان بود</span></span> <span style="font-family:B Mitra;"><span style="font-size:11.0pt;">اما</span></span> <span style="font-family:B Mitra;"><span style="font-size:11.0pt;">شدت درد در این</span></span> <span style="font-family:B Mitra;"><span style="font-size:11.0pt;">دو</span></span> <span style="font-family:B Mitra;"><span style="font-size:11.0pt;">گروه</span></span> <span style="font-family:B Mitra;"><span style="font-size:11.0pt;">به</span></span> <span style="font-family:B Mitra;"><span style="font-size:11.0pt;">طور</span></span> <span style="font-family:B Mitra;"><span style="font-size:11.0pt;">معنیداری</span></span> <span style="font-family:B Mitra;"><span style="font-size:11.0pt;">از</span></span> <span style="font-family:B Mitra;"><span style="font-size:11.0pt;">گروه</span></span> <span style="font-family:B Mitra;"><span style="font-size:11.0pt;">کنترل</span></span> <span style="font-family:B Mitra;"><span style="font-size:11.0pt;">کمتر بود. همچنین</span></span> <span style="font-family:B Mitra;"><span style="font-size:11.0pt;">میزان</span></span> <span style="font-family:B Mitra;"><span style="font-size:11.0pt;">نیاز</span></span> <span style="font-family:B Mitra;"><span style="font-size:11.0pt;">به</span></span> <span style="font-family:B Mitra;"><span style="font-size:11.0pt;">مسکن</span></span> <span style="font-family:B Mitra;"><span style="font-size:11.0pt;">در</span></span> <span style="font-family:B Mitra;"><span style="font-size:11.0pt;">گروه</span></span> <span style="font-family:B Mitra;"><span style="font-size:11.0pt;">متیل</span></span> <span style="font-family:B Mitra;"><span style="font-size:11.0pt;">پردنیزولون+بوپیواکائین</span></span> <span style="font-family:B Mitra;"><span style="font-size:11.0pt;">نسبت</span></span> <span style="font-family:B Mitra;"><span style="font-size:11.0pt;">به</span></span> <span style="font-family:B Mitra;"><span style="font-size:11.0pt;">دو</span></span> <span style="font-family:B Mitra;"><span style="font-size:11.0pt;">گروه</span></span> <span style="font-family:B Mitra;"><span style="font-size:11.0pt;">دیگر</span></span> <span style="font-family:B Mitra;"><span style="font-size:11.0pt;">به</span></span> <span style="font-family:B Mitra;"><span style="font-size:11.0pt;">طور</span></span> <span style="font-family:B Mitra;"><span style="font-size:11.0pt;">معنیداری</span></span> <span style="font-family:B Mitra;"><span style="font-size:11.0pt;">کاهش یافت</span></span><span style="font-family:B Mitra;"><span style="font-size:11.0pt;">.</span></span><br>
<strong><span dir="RTL"><span style="font-family:B Mitra;"><span style="font-size:10.0pt;">نتیجهگیری:</span></span></span></strong><span dir="RTL"><span style="font-family:B Mitra;"><span style="font-size:11.0pt;"> تزریق</span></span></span> <span dir="RTL"><span style="font-family:B Mitra;"><span style="font-size:11.0pt;">داخل</span></span></span> <span dir="RTL"><span style="font-family:B Mitra;"><span style="font-size:11.0pt;">مفصلی</span></span></span> <span dir="RTL"><span style="font-family:B Mitra;"><span style="font-size:11.0pt;">ترکیب</span></span></span> <span dir="RTL"><span style="font-family:B Mitra;"><span style="font-size:11.0pt;">متیل</span></span></span> <span dir="RTL"><span style="font-family:B Mitra;"><span style="font-size:11.0pt;">پردنیزولون+بوپیواکائین</span></span></span> <span dir="RTL"><span style="font-family:B Mitra;"><span style="font-size:11.0pt;">و</span></span></span> <span dir="RTL"><span style="font-family:B Mitra;"><span style="font-size:11.0pt;">مرفین<strong>+</strong>بوپیواکائین</span></span></span> <span dir="RTL"><span style="font-family:B Mitra;"><span style="font-size:11.0pt;">نسبت</span></span></span> <span dir="RTL"><span style="font-family:B Mitra;"><span style="font-size:11.0pt;">به</span></span></span> <span dir="RTL"><span style="font-family:B Mitra;"><span style="font-size:11.0pt;">بوپیواکائین</span></span></span> <span dir="RTL"><span style="font-family:B Mitra;"><span style="font-size:11.0pt;">بهتنهایی،</span></span></span> <span dir="RTL"><span style="font-family:B Mitra;"><span style="font-size:11.0pt;">در</span></span></span> <span dir="RTL"><span style="font-family:B Mitra;"><span style="font-size:11.0pt;">کاهش</span></span></span> <span dir="RTL"><span style="font-family:B Mitra;"><span style="font-size:11.0pt;">درد</span></span></span> <span dir="RTL"><span style="font-family:B Mitra;"><span style="font-size:11.0pt;">و</span></span></span> <span dir="RTL"><span style="font-family:B Mitra;"><span style="font-size:11.0pt;">نیاز</span></span></span> <span dir="RTL"><span style="font-family:B Mitra;"><span style="font-size:11.0pt;">به</span></span></span> <span dir="RTL"><span style="font-family:B Mitra;"><span style="font-size:11.0pt;">مسکن</span></span></span> <span dir="RTL"><span style="font-family:B Mitra;"><span style="font-size:11.0pt;">تزریقی</span></span></span> <span dir="RTL"><span style="font-family:B Mitra;"><span style="font-size:11.0pt;">مؤثرتر</span></span></span> <span dir="RTL"><span style="font-family:B Mitra;"><span style="font-size:11.0pt;">بود</span></span></span><span dir="RTL"><span style="font-family:B Mitra;"><span style="font-size:11.0pt;">ه است.</span></span></span></div>
<div style="text-align: justify;"><strong>Background and Aims:</strong> Knee arthroscopy is used to diagnose and treat intra-articular lesions. The control of acute pain after arthroscopy requires the use of a method with the least side effects and most efficacies. This study aimed to compare the sedative effect of bupivacaine in combination with morphine, methylprednisolone, or alone in knee arthroscopy after intra-articular injection.<span dir="RTL"></span><br>
<strong>Materials and Methods:</strong> This clinical-randomized three-blind trial included 99 volunteer patients with knee arthroscopy. The patients were randomly divided into three groups of bupivacaine (0.5%), morphine (5 mg)+bupivacaine (0.5%), and methylprednisolone (40 mg)+bupivacaine (0.5%). At the end of the surgical operation, the intra-articular injection of the medications were performed, and the amount of postoperative pain was evaluated and recorded based on visual analog scale 6, 12, 18, and 24 h after injection. In addition, the reception of the injected analgesic within 24 h was recorded in this study. Data were analyzed using SPSS software (version 19) through ANOVA.<br>
<strong>Results:</strong> In all three groups, the pain intensity decreased significantly over time. The pain intensity of the methylprednisolone+bupivacaine and morphine+bupivacaine groups was similar at different postoperative periods; however, the pain intensity of these groups was significantly lower than that in the control group. In addition, consumption of the analgesics was significantly reduced in the methylprednisolone+bupivacaine group, compared to the other two groups.<br>
<strong>Conclusion:</strong> The results of this study showed that the intra-articular injection of methylprednisolone+bupivacaine and morphine+bupivacaine was more effective than bupivacaine alone in reduction of pain and the need for injectable analgesia.</div>
آرتروسکوپی, بوپیواکائین, متیل پردنیزولون, مرفین, درد
Arthroscopy, Bupivacaine, Methylprednisolone, Morphine, Pain
314
322
http://journal.bums.ac.ir/browse.php?a_code=A-10-133-3&slc_lang=fa&sid=1
Hamid
Kayalha
حمید
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