人工全膝关节置换术围手术期疼痛管理现状Pain management in perioperative period of total knee arthroplasty
杨礼庆;马超;杜帅;
摘要(Abstract):
人工全膝关节置换术后疼痛会显著影响患者的术后康复、延长住院时间以及降低满意度。随着对全膝关节置换术镇痛认识的提高和镇痛方案的完善,患者术后疼痛明显改善。本文由两名研究者在CNKI,CMCI,万方数据,Pubmed,EBSCO中完成了文献检索,最终有85篇文章被纳入,对当前人工全膝关节置换术围手术期常见的疼痛管理方案及现状做一综述。结果显示,疼痛管理最早起于术前超前镇痛,贯穿于包括麻醉、手术操作、术后管理在内的全部治疗过程中。多模式镇痛方案逐渐取代单一镇痛方案已是大势所趋。本文通过对人工全膝关节置换术后镇痛方案的总结,为骨科医生全膝关节置换术后镇痛提供借鉴,更好地进行围手术期的疼痛管理,从而使患者能够在术后获得更低的疼痛评分,加速术后康复,提高手术满意度。
关键词(KeyWords): 人工全膝关节置换术;疼痛管理;超前镇痛;镇痛策略
基金项目(Foundation):
作者(Author): 杨礼庆;马超;杜帅;
Email:
DOI:
参考文献(References):
- [1]Djahani O,Rainer S,Pietsch M,et al.Systematic analysis of painful total knee prosthesis,a diagnostic algorithm[J].Arch Bone Joint Surg,2013,1(2):48-52.
- [2]Grosu I,Lavand'homme P,Thienpont E.Pain after knee arthroplasty:an unresolved issue[J].Knee Surg Sports Traumatol Arthrosc,2014,22(8):1744-1758.
- [3]Meftah M,Wong AC,Nawabi DH,et al.Pain management after total knee arthroplasty using a multimodal approach[J].Orthopedics,2012,35(5):e660-664.
- [4]董江涛,陈百成,康书峰,等.连续硬膜外阻滞用于全膝关节置换术前超前镇痛临床疗效分析[J].中国矫形外科杂志,2009,17(9):650-653.
- [5]Harsten A,Kehlet H,Toksvig-Larsen S.Recovery after total intravenous general anaesthesia or spinal anaesthesia for total knee arthroplasty:a randomized trial[J].Br J Anaesth,2013,111(3):391-399.
- [6]陈虎,曹力,杨德盛,等.麻醉方式与全膝关节置换术后深静脉血栓发生率分析[J].中国矫形外科杂志,2012,20(5):402-405.
- [7]Pilling RW,Moulder E,Allgar V,et al.Patellar resurfacing in primary total knee replacement:a meta-analysis[J].J Bone Joint Surg Am,2012,94(24):2270-2278.
- [8]Pulavarti RS,Raut VV,Mc Lauchlan GJ.Patella denervation in primary total knee arthroplasty-a randomized controlled trial with 2years of follow-up[J].J Arthroplasty,2014,29(5):977-981.
- [9]Baliga S,Mc Nair CJ,Barnett KJ,et al.Does circumpatellar electrocautery improve the outcome after total knee replacement:a prospective,randomised,blinded controlled trial[J].J Bone Joint Surg Br,2012,94(9):1228-1233.
- [10]Wang YC,Teng WN,Kuo IT,et al.Patient-machine interactions of intravenous patient-controlled analgesia in bilateral versus unilateral total knee arthroplasty:a retrospective study[J].J Chin Med Assoc,2013,76(6):330-334.
- [11]Al-Zahrani T,Doais KS,Aljassir F,et al.Randomized clinical trial of continuous femoral nerve block combined with sciatic nerve block versus epidural analgesia for unilateral total knee arthroplasty[J].J Arthroplasty,2015,30(1):149-154.
- [12]Rawal N.Epidural technique for postoperative pain:gold standard no more[J].Reg Anesth Pain Med,2012,37(3):310-317.
- [13]Spreng UJ,Dahl V,Hjall A,et al.High-volume local infiltration analgesia combined with intravenous or local ketorolac+morphine compared with epidural analgesia after total knee arthroplasty[J].Br J Anaesth,2010,105(5):675-682.
- [14]Bachmann M,Laakso E,Niemi L,et al.Intrathecal infusion of bupivacaine with or without morphine for postoperative analgesia after hip and knee arthroplasty[J].Br J Anaesth,1997,78(6):666-670.
- [15]Lauretti GR,Righeti CC,Mattos AL.Intrathecal ketorolac enhances intrathecal morphine analgesia following total knee arthroplasty[J].J Anaesthesiol Clin Pharmacol,2013,29(4):503-508.
- [16]Sakai N,Inoue T,Kunugiza Y,et al.Continuous femoral versus epidural block for attainment of 120°knee flexion after total knee arthroplasty:a randomized controlled trial[J].J Arthroplasty,2013,28(5):807-814.
- [17]Chan EY,Fransen M,Sathappan S,et al.Comparing the analgesia effects of single-injection and continuous femoral nerve blocks with patient controlled analgesia after total knee arthroplasty[J].J Arthroplasty,2013,28(4):608-613.
- [18]Sharma S,Iorio R,Specht LM,et al.Complications of femoral nerve block for total knee arthroplasty[J].Clin Orthop,2010,468(1):135-140.
- [19]Sato K,Adachi T,Shirai N,et al.Continuous versus single-injection sciatic nerve block added to continuous femoral nerve block for analgesia after total knee arthroplasty:a prospective,randomized,double-blind study[J].Reg Anesth Pain Med,2014,39(3):225-229.
- [20]Bergeron SG,Kardash KJ,Huk OL,et al.Functional outcome of femoral versus obturator nerve block after total knee arthroplasty[J].Clin Orthop,2009,467(6):1458-1462.
- [21]Hanson NA,Allen CJ,Hostetter LS,et al.Continuous ultrasoundguided adductor canal block for total knee arthroplasty:a randomized,double-blind trial[J].Anesth Analg,2014,118(6):1370-1377.
- [22]Memtsoudis SG,Yoo D,Stundner O,et al.Subsartorial adductor canal vs femoral nerve block for analgesia after total knee replacement[J].Int Orthop,2015,39(4):673-680.
- [23]Quinn M,Deakin AH,Mc Donald DA,et al.An anatomic study of local infiltration analgesia in total knee arthroplasty[J].Knee,2013,20(5):319-323.
- [24]Sean VW,Chin PL,Chia SL,et al.Single-dose periarticular steroid infiltration for pain management in total knee arthroplasty:a prospective,double-blind,randomised controlled trial[J].Singapore Med J,2011,52(1):19-23.
- [25]Carli F,Clemente A,Asenjo JF,et al.Analgesia and functional outcome after total knee arthroplasty:periarticular infiltration vs continuous femoral nerve block[J].Br J Anaesth,2010,105(2):185-195.
- [26]Ni SH,Jiang WT,Guo L,et al.Cryotherapy on postoperative rehabilitation of joint arthroplasty[J].Knee Surg Sports Traumatol Arthrosc,2015,23(11):3354-3361.
- [27]Adie S,Naylor JM,Harris IA.Cryotherapy after total knee arthroplasty:a systematic review and meta-analysis of randomized controlled trials[J].J Arthroplasty,2010,25(5):709-715.
- [28]Chen CC,Yang CC,Hu CC,et al.Acupuncture for pain relief after total knee arthroplasty:a randomized controlled trial[J].Reg Anesth Pain Med,2015,40(1):31-36.