Background. Local infiltration analgesia (LIA) provides postoperative analgesia for total knee arthroplasty (TKA). The purpose of this study was to evaluate the analgesic effect of a cocktail of ropivacaine, morphine, and Diprospan for TKA. Methods. A total of 100 patients from September 2018 to February 2019 were randomized into 2 groups. Group A (control group, 50 patients) received LIA of ropivacaine alone (80 ml, 0.25% ropivacaine). Group B (LIA group, 50 patients) received an LIA cocktail of ropivacaine, morphine, and Diprospan (80 ml, 0.25% ropivacaine, 0.125 mg/ml morphine, and 62.5 μg/ml compound betamethasone). The primary outcomes were the levels of inflammatory markers C-reactive protein (CRP) and interleukin-6 (IL-6), pain visual analog scale (VAS) scores, opioid consumption, range of motion (ROM), functional tests, and sleeping quality. The secondary outcomes were adverse events, satisfaction rates, HSS scores, and SF-12 scores. The longest follow-up was 2 years. Results. The two groups showed no differences in terms of characteristics (). Group B had lower resting VAS pain scores (1.54 ± 0.60, 95% CI = 1.37 to 1.70 vs. 2.00 ± 0.63, 95% CI = 2.05 to 2.34) and active VAS pain scores (2.64 ± 0.62, 95% CI = 2.46 to 2.81 vs. 3.16 ± 0.75, 95% CI = 2.95 to 3.36) within 48 h postoperatively than Group A (), while none of the pain differences exceeded the minimal clinically important difference (MCID). Group B had significantly lower CRP levels (59.49 ± 13.01, 95% CI = 55.88 to 63.09 vs. 65.95 ± 14.41, 95% CI = 61.95 to 69.94) and IL-6 levels (44.11 ± 13.67, 95% CI = 40.32 to 47.89 vs. 60.72 ± 15.49, 95% CI = 56.42 to 65.01), lower opioid consumption (7.60 ± 11.10, 95% CI = 4.52 to 10.67 vs. 13.80 ± 14.68, 95% CI = 9.73 to 17.86), better ROM (110.20 ± 10.46, 95% CI = 107.30 to 113.09 vs. 105.30 ± 10.02, 95% CI = 102.52 to 108.07), better sleep quality (3.40 ± 1.03, 95% CI = 3.11 to 3.68 vs. 4.20 ± 1.06, 95% CI = 3.90 to 4.49), and higher satisfaction rates than Group A within 48 h postoperatively (). Adverse events, HSS scores, and SF-12 scores were not significantly different within 2 years postoperatively. Conclusions. A cocktail of ropivacaine, morphine, and Diprospan prolongs the analgesic effect up to 48 h postoperatively. Although the small statistical benefit may not result in MCID, the LIA cocktail still reduces opioid consumption, results in better sleeping quality and faster rehabilitation, and does not increase adverse events. Therefore, cocktails of ropivacaine, morphine, and Diprospan have good application value for pain control in TKA. This trial is registered with ChiCTR1800018372.

中文翻译：

---

罗哌卡因、吗啡和得宝松的混合物可减轻全膝关节置换术后的疼痛并延长镇痛效果：一项前瞻性随机对照试验

背景。局部浸润镇痛（LIA）为全膝关节置换术（TKA）提供术后镇痛。本研究的目的是评估罗哌卡因、吗啡和得宝松混合液对 TKA 的镇痛效果。方法。2018年9月至2019年2月共100名患者被随机分为2组。A组（对照组，50名患者）接受单独罗哌卡因的LIA（80ml，0.25%罗哌卡因）。B组（LIA组，50例患者）接受罗哌卡因、吗啡和得普松的LIA混合物（80ml，0.25％罗哌卡因，0.125mg/ml吗啡和62.5μg/ml 复方倍他米松）。主要结果是炎症标志物 C 反应蛋白 (CRP) 和白细胞介素 6 (IL-6) 的水平、疼痛视觉模拟量表 (VAS) 评分、阿片类药物消耗量、活动范围 (ROM)、功能测试和睡眠质量。次要结局是不良事件、满意度、HSS 评分和 SF-12 评分。最长的随访时间为2年。结果。两组在特征方面没有差异（）。B 组的静息 VAS 疼痛评分较低（1.54 ± 0.60，95% CI = 1.37 至 1.70 对比 2.00 ± 0.63，95% CI = 2.05 至 2.34），活动 VAS 疼痛评分较低（2.64 ± 0.62，95% CI = 2.46 至术后 48 小时内比 A 组 (2.81 vs. 3.16 ± 0.75, 95% CI = 2.95 to 3.36)），而疼痛差异均不超过最小临床重要差异（MCID）。B 组的 CRP 水平（59.49 ± 13.01，95% CI = 55.88 至 63.09 对比 65.95 ± 14.41，95% CI = 61.95 至 69.94）和 IL-6 水平显着较低（44.11 ± 13.67，95% CI = 40.32 至 47.89）对比 60.72 ± 15.49，95% CI = 56.42 至 65.01），阿片类药物消耗量较低（7.60 ± 11.10，95% CI = 4.52 至 10.67 对比 13.80 ± 14.68，95% CI = 9.73 至 17.86），更好的 ROM（110.20 ± 10.46，95% CI = 107.30 至 113.09 对比 105.30 ± 10.02，95% CI = 102.52 至 108.07），睡眠质量更好（3.40 ± 1.03，95% CI = 3.11 至 3.68 对比 4.20 ± 1.06，95% CI = 3.9） 0达到4.49），术后48小时内满意度高于A组（）。术后 2 年内不良事件、HSS 评分和 SF-12 评分无显着差异。结论。罗哌卡因、吗啡和得宝松的混合物可将镇痛效果延长至术后 48 小时。尽管微小的统计益处可能不会导致 MCID，但 LIA 鸡尾酒仍然可以减少阿片类药物的消耗，带来更好的睡眠质量和更快的康复，并且不会增加不良事件。因此，罗哌卡因、吗啡、得宝松复配制剂对于TKA疼痛控制具有良好的应用价值。该试验已在 ChiCTR1800018372 上注册。