总体,脊柱和区域神经阻塞:不同的麻醉实践是否会影响初级全关节和膝关节整形手术的同一天出院?
Clayton W Wing1, Behnaz Hatami2, Ahmad T Oseili2
1Department of Orthopedic Surgery, Mayo Clinic, 4500 San Pablo Road, Jacksonville, FL 32224.
The Journal of arthroplasty
|December 20, 2025
概括
脊髓麻醉 (SA) 与全身麻醉 (GA) 相比,改善了同日出院的关节和膝盖置换患者的疼痛控制. 麻醉剂降低了麻醉剂的使用和疼痛得分,但没有影响恢复,尽管外围神经阻断的有效性各不相同.
科学领域:
- 整形外科手术 整形外科手术
- 麻醉学 麻醉学
- 疼痛管理 疼痛管理
背景情况:
- 同日出院 (SDD) 协议越来越多地用于全关节整形 (THA) 和全膝关节整形 (TKA).
- 麻醉选择可能会影响SDD关节整形患者的急性结局.
- 周围神经阻塞 (PNBs) 经常被用来作为辅助.
研究的目的:
- 为了比较脊髓麻醉 (SA) 与全身麻醉 (GA) 在SDD THA和TKA患者的急性90天结果.
- 分析SA.内PNBs (THA的准脊椎阻塞,TKA的附带管道阻塞) 的影响.
- 为了评估麻醉剂的使用,疼痛评分,行走,停留时间和并发症.
主要方法:
- 对1002名SDDTHA/TKA患者 (868名SA,134名GA) 的回顾性审查.
- 所有患者都接受了多模式止痛和周关节注射.
- 收集的数据包括手术内/术后麻醉剂使用 (MME),疼痛评分,行走,LOS和90天后的并发症.
主要成果:
- 与GA相比,SA显著降低了THA和TKA的手术内和术后麻醉剂使用 (MME) 和疼痛分数.
- 在SA和GA组之间没有观察到停留时间 (LOS) 的差异.
- 接受GA治疗的THA患者的90天再入院率更高 (4.8%对0.3%).
- 在SA THA患者中,准脊椎阻塞 (PVB) 减少了术后的MME和疼痛;在SA TKA患者中,添加管道阻塞 (ACB) 显示出最小的益处.
结论:
- 与GA相比,SA为SDDTHA/TKA患者提供了优越的手术内和手术后立即疼痛管理.
- SA不会对急性恢复结果产生负面影响.
- 在SA THA中,PVBs提供了适度的疼痛改善,而在SA TKA中,ACBs在当代多式调节止痛疗法中没有显著增强疼痛控制.
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