关节手术中区域麻醉的回顾性分析:临床审计
P Casas Reza1, M Gestal Vázquez1, L Sampayo Rodríguez1
1Departamento de Anestesiología, Reanimación y Terapéutica del Dolor, Complexo Hospitalario Universitario de A Coruña, A Coruña, Galicia, Spain.
Revista espanola de anestesiologia y reanimacion
|February 14, 2024
概括
外围神经阻断,包括周囊神经群 (PENG) 阻断,在全关节整形术后有效降低阿片类药物消耗. 这些区域麻醉技术提供阿片类药物节约的好处,神经损伤或长期运动阻塞的发生率很低.
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:
- 整部关节整形术 (THA) 是一种常见的手术,在治疗术后疼痛方面存在持续的挑战.
- 多模式止痛,特别是区域麻醉技术,显示出优化疼痛控制的前景.
- 不同的外围神经阻断对THA疼痛的比较疗效仍然是一个研究领域.
研究的目的:
- 评估外围神经阻塞 (大腿骨,下腹筋,PENG阻塞) 对THA后的术后疼痛的影响.
- 为了在不同类型的区块和无区块组中比较静脉注射吗啡消费和阿片类药物救援需求.
- 评估二次结果,包括神经损伤和长期四头骨阻塞的发生率.
主要方法:
- 在2018年4月至2020年8月期间,对362名接受初级THA治疗的患者进行了回顾性观察研究.
- 患者在外围神经阻塞 (股骨,PENG, iliaca Fascia) 时使用levobupivacaine进行全身或脑下麻醉.
- 收集的数据包括在麻醉后护理单位 (PACU) 的术后阿片类药物消费和24小时和48小时的阿片类药物救援.
主要成果:
- 与没有阻断 (6.69毫克) 相比,PENG阻断 (2.2毫克) 和股骨阻断 (3.27毫克) 的平均PACU阿片类药物消耗显著降低.
- 在手术后24或48小时内,没有观察到阿片类药物救援需求的显著差异.
- 神经损伤 (0.8%) 和长期四头 (1.3%) 的发病率较低;主要与股骨神经阻塞有关.
结论:
- 区域神经阻塞,包括PENG和股骨阻塞,在THA后作为有效的阿片类药物节约策略.
- 这些技术有助于更好的疼痛管理,而不会增加救援止痛的需要.
- 外围神经阻塞与快速的功能恢复和最小的运动障碍有关.
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