在慢性阿片类药物患者中进行初级全膝关节关节整形手术的区域神经阻塞
Cameron K Ledford1, Nicolas E Giusti1, Daniel S Ubl1
1Department of Orthopedic Surgery, Mayo Clinic, Jacksonville, Florida.
The journal of knee surgery
|July 30, 2025
概括
经过全膝关节整形手术 (TKA) 的慢性阿片类药物使用者需要更多的术后阿片类药物. 然而,添加管道阻塞 (ACB) 改善了这些患者的疼痛控制,减少了停留时间和出院疼痛评分.
科学领域:
- 整形外科手术 整形外科手术
- 疼痛管理 疼痛管理
- 麻醉学 麻醉学
背景情况:
- 在全膝关节整形术 (TKA) 后的术后疼痛管理具有挑战性,特别是对于术前慢性阿片类药物使用的患者.
- 在这种患者群体中优化疼痛控制对于康复和患者满意度至关重要.
研究的目的:
- 为了评估区域神经阻塞对TKA患者的外科手术期间疼痛控制的影响,有或没有慢性外科前阿片类药物使用.
- 根据使用的区域阻塞类型 (输入管道阻塞[ACB]与无阻塞) 进行对比结果.
主要方法:
- 对434名慢性阿片类药物使用的TKA患者的回顾性审查,与非阿片类药物使用者匹配1:1.
- 患者根据区域阻塞类型进行分类:一次性ACB注射,3天ACB导管或没有阻塞.
- 分析的结果包括住院阿片类药物使用,住院时间 (LOS),出院疼痛得分,90天再入院率和膝关节关节炎结局得分,初级 (KOOS,Jr).
主要成果:
- 慢性阿片类药物使用者表现出比对照患者的住院阿片类药物消费量更高 (90 vs 65 OMEs),在LOS,出院疼痛,再入院或KOOS,Jr.方面没有显著差异.
- 在慢性阿片类药物使用者中,那些没有阻断的人比那些接受任何ACB的人有更高的LOS,出院疼痛得分和住院阿片类药物使用.
- 与其他组相比,ACB导管组显示出明显更高的90天再入院率 (9%).
结论:
- 患有TKA前慢性阿片类药物的患者需要增加术后阿片类药物治疗,即使有多种模式的疼痛管理.
- 附带管道阻塞 (ACB),无论是单次射击还是导管,为经历TKA的慢性阿片类药物使用者提供了改善的疼痛控制.
- 虽然ACB可以改善疼痛控制,但需要仔细考虑ACB导管可能增加的再入院率.
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
Analgesia and Pain Management
803
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...
803
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
Opioid Analgesics: Synthetic and Semisynthetic Opioids
437
Synthetic and semisynthetic opioids are pivotal in pain management and tackling opioid addiction. Semisynthetic opioids, including morphinans (morphine derivatives), oxycodone, oxymorphone, hydrocodone, and hydromorphone, have improved pharmacokinetic profiles compared to morphine. Additionally, heroin and 6-MAM (6-Monoacetylmorphine) show better CNS penetration than morphine due to heightened lipid solubility. Hydromorphone, a potent opioid, undergoes hepatic metabolism to form the active...
437
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


