在全膝关节整形术后,多维疼痛评估和阿片类药物使用:连续 vs 单次注射区域 vs 系统性止痛
Michael A Harnik1,2, Oskar Oswald1, Markus Huber1
1Department of Anaesthesiology and Pain Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.
Pain reports
|March 20, 2025
概括
连续外围神经阻塞 (PNBc) 在全膝关节整形术后对于缓解疼痛或使用阿片类药物而言,与单次注射外围神经阻塞 (PNBs) 没有明显的优势. 建议对综合性患者报告结果进行进一步的研究.
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:
- 有效的疼痛管理对于全膝关节整形术 (TKA) 后的恢复至关重要.
- 连续外围神经阻塞 (PNBc) 通常被认为与单次注射外围神经阻塞 (PNBs) 相比,可以提供更好的缓解疼痛.
- 在TKA之后,患者报告的与多维疼痛相关的结果 (PROs) 尚未在这些块类型的比较研究中得到广泛评估.
研究的目的:
- 为了在接受TKA的患者中比较疼痛强度,术后阿片类药物消耗和其他患者报告的连续外周神经阻塞 (PNBc) 和单次注射外周神经阻塞 (PNBs) 之间的结果.
- 分析注册数据,以评估不同麻醉和神经阻断组合在TKA后疼痛管理的疗效.
主要方法:
- 分析了从4,328名接受TKA的成年患者的注册数据.
- 患者根据麻醉类型 (全身麻醉[GA]或脊髓麻醉[SA]) 和神经阻塞类型 (单次注射[PNBs]或通过导管[PNBc]连续注射) 分类.
- 主要终点是24小时内疼痛综合评分 (PCS);次要终点包括阿片类药物使用和额外的PROs.
主要成果:
- 在全身麻醉下持续的外围神经阻塞 (GA&PNBc) 与单次注射阻塞 (GA&PNBs) 相比,与更高的疼痛复合得分有关.
- 与单次注射药物相比,连续外围神经阻塞 (GA&PNBc和SA&PNBc) 的阿片类药物使用频率明显高.
- 虽然PNBc组的患者报告结果得分更高,但整体优势在PNBs上并没有被清楚地证明.
结论:
- 连续外围神经阻塞 (PNBc) 在TKA中没有表现出与单次注射外围神经阻塞 (PNBs) 相比的明显优势,关于缓解疼痛,使用阿片类药物或患者报告的结果.
- 该研究强调了在评估TKA的止痛技术时需要全面的PROs.
- 未来的研究应侧重于纳入更广泛的PRO,以更好地评估TKA后不同疼痛管理策略的比较有效性.
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