主要全关节整形术的区域麻醉方式:系统性审查和组件网络元分析
Kun-Han Lee1, Jui-Chien Wang1, Cheng-Yang Chang1
1Department of Orthopaedics and Traumatology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC; Department of Orthopaedics, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC.
British journal of anaesthesia
|June 7, 2025
概括
结合区域麻醉技术,如环囊神经群 (PENG) 阻断与局部透性止痛疗法 (LIA),在关节置换手术后提供优越的疼痛管理. 这些方法可以减少疼痛和阿片类药物使用,同时保持肌肉功能.
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:
- 区域性神经阻塞可以改善初级关节整形手术中的疼痛控制.
- 这种手术的最佳单次区域麻醉技术尚未确定.
研究的目的:
- 为了比较各种一次性区域麻醉方式的疗效,用于初级全关节整形手术.
- 确定控制疼痛,消费阿片类药物和功能恢复的最佳技术.
主要方法:
- 来自主要数据库 (PubMed,Embase,Cochrane,Web of Science) 的随机对照试验 (RCT) 的系统审查和元分析.
- 进行了频率主义和组件网络元分析.
- 主要结局包括静态和动态疼痛 (VAS) 在6小时和12小时,以及24小时的吗啡消耗.
主要成果:
- 在分析中包括了87个RCT.
- 对于6小时后的静态疼痛,股骨神经阻塞排名最高,其次是腰椎阻塞 (LPB) 加上局部透性止痛疗法 (LIA).
- 在12小时后,LPB加LIA在静态疼痛方面排名最高,而周囊神经组 (PENG) 阻断加LIA导致动态疼痛.
- 四角腰部块加上腹筋腹部区块 (FICB) 显示24小时吗啡消耗量最低.
结论:
- 联合区域麻醉技术,特别是PENG阻断加LIA,对于初级全关节整形术是有效的.
- 这些方法导致手术后疼痛减少,阿片类药物需求降低,并保持运动功能.
相关概念视频
Local Anesthetics: Clinical Application as Intravenous Regional Anesthesia
606
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...
606
Local Anesthetics: Clinical Application as Spinal Anesthesia
821
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...
821
Local Anesthetics: Clinical Application as Epidural Anesthesia
509
Epidural anesthetics are administered in the fat-filled epidural space, the outermost part of the spinal canal. This technique is commonly employed for pain management and anesthesia during lower abdomen and pelvis surgeries or labor and delivery.
Since epidural anesthetics can be infused through an epidural catheter, all types of drugs, including short-acting ones, can be administered. Chloroprocaine and lidocaine are examples of short and long-duration anesthetics, respectively. Bupivacaine...
Since epidural anesthetics can be infused through an epidural catheter, all types of drugs, including short-acting ones, can be administered. Chloroprocaine and lidocaine are examples of short and long-duration anesthetics, respectively. Bupivacaine...
509
Local Anesthetics: Clinical Application as Surface, Infiltration, and Conduction Block Anesthesia
1.3K
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...
1.3K
General Anesthesia: Overview
308
Anesthesia is a medical procedure that uses drugs for CNS suppression to enable painless surgeries and procedures. The selection of anesthetics is influenced by their pharmacokinetic properties, side effects, and patient characteristics. Various types of anesthesia include general, local, regional, spinal, and inhalational.
General anesthesia induces unconsciousness in the whole body, while the others target specific areas or sensations. It is administered to minimize adverse effects, maintain...
General anesthesia induces unconsciousness in the whole body, while the others target specific areas or sensations. It is administered to minimize adverse effects, maintain...
308
Analgesia and Pain Management
823
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...
823


