膝关节关节整形术后的慢性术后疼痛:外围神经阻塞的作用
Svetlana Sreckovic1,2, Nebojsa Ladjevic1,3, Biljana Milicic4,5
1Centre of Anaesthesia and Resuscitation, University Clinical Centre of Serbia, Belgrade, Serbia.
Frontiers in medicine
|January 26, 2024
概括
周围神经阻断显著减少了阿片类药物消费和慢性术后疼痛 (CPSP) 在膝关节全关节整形术 (TKA) 后两年. 这项研究强调了神经阻塞对TKA患者的长期益处.
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:
- 周围神经阻塞被认为是膝关节全关节整形术 (TKA) 后有效的疼痛管理.
- 然而,它们在TKA后对慢性术后疼痛 (CPSP) 的长期影响仍未得到充分报道.
研究的目的:
- 评估添加管道阻断 (ACB) 和IPACK阻断对阿片类药物消费,疼痛得分以及TKA后长达两年的CPSP发生率的影响.
- 为了确定TKA患者中CPSP的预测因子.
主要方法:
- 一项前性观察性研究,涉及166名接受TKA的患者.
- 患者被分为两组:接受神经阻塞 (ACB和IPACK) 的人和没有接受神经阻塞的人.
- 评估了阿片类药物的消费,疼痛评分和两年后CPSP的存在.
主要成果:
- 接受神经阻塞的患者的阿片类药物消费量明显降低 (9.74 ± 3.87毫克 vs 30.63 ± 11.52毫克,p < 0.001).
- 在神经阻塞组中,CPSP的发生率大幅降低 (6.1%对20.24%,p = 0.011).
- 手术前的疼痛,休息时/运动期间的疼痛以及阿片类药物消费被确定为CPSP的预测因素.
结论:
- 外围神经阻塞在TKA后有效提供止痛.
- 这些阻断剂显著降低了阿片类药物需求,并减少了TKA后两年慢性术后疼痛的发生率.
- 神经阻塞改善了全膝关节整形术后的功能结果和长期疼痛管理.
相关概念视频
Analgesia and Pain Management
623
Pain is critical to various clinical pathologies, provoking an urgent need for effective management. Pain, whether acute or chronic, is a complex neurochemical process. Its alleviation depends on the type, with nonopioid analgesics effective for mild to moderate pain, such as musculoskeletal or inflammatory pain, while neuropathic pain responds best to anticonvulsants, tricyclic antidepressants, or serotonin/norepinephrine reuptake inhibitors. For severe acute or chronic pain, opioids may be...
623
Local Anesthetics: Clinical Application as Intravenous Regional Anesthesia
417
Intravenous regional anesthesia or the Bier block technique is used to anesthetize a specific limb or extremity. It uses exsanguinated or blood-drained vessels to transport local anesthetics or LAs to the peripheral nerve trunks. Lidocaine without vasoconstrictors like epinephrine is most commonly used for this technique. Other drugs used are prilocaine, ropivacaine, and chloroprocaine. Bupivacaine is not recommended for this technique due to its high cardiac toxicity.
One of the advantages of...
One of the advantages of...
417
Nociception
27.9K
Nociception—the ability to feel pain—is essential for an organism’s survival and overall well-being. Noxious stimuli such as piercing pain from a sharp object, heat from an open flame, or contact with corrosive chemicals are first detected by sensory receptors, called nociceptors, located on nerve endings. Nociceptors express ion channels that convert noxious stimuli into electrical signals. When these signals reach the brain via sensory neurons, they are perceived as pain.
27.9K
Local Anesthetics: Clinical Application as Surface, Infiltration, and Conduction Block Anesthesia
1.1K
Depending on the target organ, local anesthetics (LAs) can be administered via various routes. In surface anesthesia, LAs are applied directly to the surface of the skin or mucous membranes. It is widely used for topical skin numbing before venipuncture or minor surgical procedures. Commonly used surface local anesthetics are lidocaine or benzocaine sprays or creams. Surface anesthesia occurs within 5 minutes and lasts for about 60 minutes. One of the main disadvantages of topical anesthesia is...
1.1K
Local Anesthetics: Clinical Application as Spinal Anesthesia
632
Spinal anesthetics are given during lower abdomen and limb surgeries to block sensory and motor neurons. They are administered in the mid to low lumbar regions, primarily acting on the cauda equina's nerve roots. The blockade level depends on the local anesthetic (LA) concentration. Usually, low LA concentrations are sufficient to block sensory fibers, while only high LA concentrations block motor fibers. Other factors like injection volume and speed, the patient's posture, and the drug...
632
Blood and Nerve Supply to the Bones
11.0K
Bones are dynamic organs that require a rich supply of oxygen and nutrients. Around 5% to 10% of the cardiac output supplies blood to the bones. A typical long bone has three main sources: the nutrient artery, the metaphyseal and epiphyseal arteries, and the periosteal arteries.
Nutrient Artery
The nutrient artery is the main blood vessel that enters the diaphysis via the nutrient foramen. While most long bones have only one nutrient foramen, large bones, such as the femur, may have two. This...
Nutrient Artery
The nutrient artery is the main blood vessel that enters the diaphysis via the nutrient foramen. While most long bones have only one nutrient foramen, large bones, such as the femur, may have two. This...
11.0K


