降低阿片类药物需求,以改变区域麻醉的患者接受全膝关节关节整形手术后的区域麻醉
Jeffrey Mauras1, Michael McMahon2, Jaudé Petrie3
1Physical Medicine and Rehabilitation Pain Medicine, Louisiana State University Health Sciences Center, New Orleans, LA.
Ochsner journal
|June 20, 2025
概括
与ropivacaine相比,用于全膝关节整形术 (TKA) 的多模式止痛药,可显著减少阿片类药物使用,改善患者报告的疼痛结果. 这为TKA后提供了更好的恢复.
科学领域:
- 整形外科 整形外科 整形外科
- 麻醉学 麻醉学
- 疼痛管理 疼痛管理
背景情况:
- 全膝关节整形术 (TKA) 恢复可能涉及严重的疼痛和阿片类药物的使用.
- 新型止痛技术,如添加管道阻断 (ACB) 和iPACK阻断,旨在缓解这些问题.
- 优化区域麻醉剂对于改善术后疼痛管理至关重要.
研究的目的:
- 为了比较脂质体布皮瓦卡因与罗皮瓦卡因在TKA后区域止痛中的疗效.
- 评估这些止痛药对阿片类药物消费和患者在TKA后2周和12周报告的疼痛结果的影响.
主要方法:
- 对140名TKA患者进行了回顾性审查.
- 患者接受了多模式罗皮瓦卡因 (MM-R) 或多模式脂质体布皮瓦卡因 (MM-LB) 与ACB/iPACK阻断剂.
- 主要结局包括吗啡毫克相当量 (MME) 和患者报告的疼痛评分 (KOOS,PROMIS).
主要成果:
- 与MM-R组 (P<0.0001) 相比,MM-LB组显示出出院 (65%的减少) 和阿片类药物总处方 (48%的减少) 的MME中位数显著降低 (P<0.0001).
- 在MM-LB组的患者在2周的术后记号报告了显著更好的结果.
- 在12周后没有发现显著差异,这表明短期效益.
结论:
- 基于脂质体bupivacaine的区域止痛,作为多模式方法的一部分,有效地减少了TKA后的阿片类药物需求.
- 这种止痛策略还改善了患者在急性和短期康复阶段报告的结果.
- 脂质体布皮瓦卡因 (liposomal bupivacaine) 是用于TKA疼痛管理中对罗皮瓦卡因 (ropivacaine) 的一个有价值的替代品.
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