麻醉选择对手术后治疗关节骨折的术后疼痛管理的影响
Jana M Davis1, Mario Cuadra1, Tamar Roomian1
1Department of Orthopaedic Surgery, Atrium Health Musculoskeletal Institute, Charlotte, North Carolina.
关节骨折患者的外围神经阻断 (PNB) 与全身麻醉相比,减少了早期的术后阿片类药物使用. 然而,PNB并没有防止像狂妄症这样的并发症.
科学领域:
- 麻醉学 麻醉学
- 整形外科手术 整形外科手术
- 疼痛管理 疼痛管理
背景情况:
- 骨折在老年患者中很常见,通常需要手术干预.
- 有效的疼痛管理对于术后恢复和减少阿片类药物依赖至关重要.
研究的目的:
- 为了比较周围神经阻断 (PNB) 与局部透止痛 (LIA) 在关节骨折手术后减少阿片类药物消耗的有效性.
- 评估这些镇痛技术对术后并发症和停留时间的影响.
主要方法:
- 在588名患有部骨折的患者进行了回顾性队列研究 (AO/OTA 31A和31B).
- 患者接受单独全身麻醉 (GA),GA与PNB,或GA与LIA.
- 分析了阿片类药物的消费 (吗啡毫克相当量),停留时间和并发症.
主要成果:
- 与GA单独相比,PNB在术后24小时和48小时显著减少了阿片类药物的使用.
- 停留时间较长 (≥10天) 与阿片类药物使用量增加有关.
- 与GA相比,PNB与术后并发症的发病率更高,包括妄想症.
结论:
- 周围神经阻断可以是一个有效的策略,以限制关节骨折患者的术后阿片类药物需求.
- 像PNB这样的区域镇痛技术似乎无法预防术后妄想等并发症.
- 在将LIA与全身麻醉进行比较时,没有观察到结果的显著差异.
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