从疼痛控制到早期移动性:老年人整体关节整形术中区域麻醉的演变
Tomasz Reysner1, Grzegorz Kowalski1, Aleksander Mularski2
1Department of Palliative Medicine, Poznan University of Medical Sciences, 61-701 Poznan, Poland.
Reports (MDPI)
|July 25, 2025
概括
新的运动节约区域麻醉技术为关节整形术患者,特别是老年人提供了改善的疼痛控制和更快的恢复. 这些先进的块可最大限度地减少运动障碍,降低跌倒风险,增强手术后的功能独立性.
科学领域:
- 麻醉学和疼痛管理
- 老年人骨科的骨科治疗
- 手术恢复协议 手术恢复协议
背景情况:
- 对于全关节整形术 (THA) 的传统神经阻塞通常会导致运动障碍,延迟患者的动员,增加跌倒风险.
- 优化老年THA患者的术后疼痛管理是关键的,因为与年龄有关的生理脆弱性.
- 手术后增强恢复 (ERAS) 协议强调早期的流动性和减少阿片类药物的使用.
研究的目的:
- 审查和突出显示THA的运动节约区域麻醉技术的进步.
- 为了比较运动节约阻塞与老年患者传统神经阻塞的益处.
- 讨论这些技术在改善术后康复和患者安全方面的潜力.
主要方法:
- 对THA区域麻醉的当前文献的综述.
- 专注于运动节约技术:围神经群 (PENG) 阻断,上腹膜下 iliaca 阻断 (SI-FIB),直立脊柱平面阻断 (ESPB) 和四角腰部阻断 (QLB).
- 结果的比较包括疼痛控制,运动功能的保存,阿片类药物消耗和功能恢复.
主要成果:
- 节约运动的阻塞提供有效的止痛药与最小的运动软弱,促进较早的行走.
- 这些技术减少了阿片类药物需求,并与ERAS原则保持一致,缩短了住院时间.
- 研究表明,老年THA患者的功能恢复得到改善,手术后跌倒的风险降低.
结论:
- 运动节约区域麻醉在THA疼痛管理方面取得了重大进展,特别是在老年患者中.
- 这些技术通过保护运动功能和降低跌倒风险来提高患者的安全性.
- 需要进一步的研究来规范协议,并确认广泛采用的长期好处.
相关概念视频
Local Anesthetics: Clinical Application as Intravenous Regional Anesthesia
584
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...
584
Local Anesthetics: Clinical Application as Epidural Anesthesia
499
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...
499
Local Anesthetics: Clinical Application as Spinal Anesthesia
789
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...
789
General Anesthesia: Overview
283
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...
283
Local Anesthetics: Clinical Application as Surface, Infiltration, and Conduction Block Anesthesia
1.2K
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...
1.2K
Parenteral Anesthetics: Overview
199
Intravenous anesthetics are drugs administered parenterally to induce anesthesia or sedation. Propofol is a widely used agent formulated as a 1% emulsion in soybean oil, glycerol, and egg phosphatide. It induces rapid anesthesia primarily due to its rapid distribution from the bloodstream to target tissues and is metabolized in the liver. However, it can cause significant pain on injection and hypertriglyceridemia. Fospropofol, a water-based prodrug of propofol, lacks these adverse effects.
199


