使用脂质体布皮瓦卡因的区域麻醉,有或没有甲,在前十字带重建后提供了优秀的疼痛控制,并最大限度地减少了阿片类药物消费
William L Johns1, Armen Voskeridjian2, Benjamin Miltenberg1
1Rothman Orthopaedics at Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA.
Orthopaedic journal of sports medicine
|January 12, 2026
概括
在前十字带重建 (ACLR) 后,带有或没有德克萨米他的脂质体布皮瓦卡因 (LB) 提供了很好的疼痛控制. 大多数患者不需要阿片类药物,证明了无阿片类药物ACLR的潜力,并最大限度地减少处方阿片类药物浪费.
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:
- 在前交叉带重建 (ACLR) 后,外科神经阻塞是治疗疼痛的标准.
- 脂质体布皮瓦卡因 (LB) 提供长达72小时的延长神经阻塞.
- 在理论上,除了LB (LB+dex),还添加了甲,以延长止痛效果.
研究的目的:
- 为了评估疼痛控制和阿片类药物使用与添加管道阻断 (ACB),iPACK,并使用LB后ACLR.suprasartorial透 (SSI) 使用LB后ACLR.
- 为了比较这些区域麻醉技术的LB与LB+dex.
主要方法:
- 一项随机对照试验 (一级证据) 包括131名接受初级ACLR.患者.
- 所有患者都接受了手术前的ACB,iPACK和SSI治疗.
- 患者被随机分配给接受LB或LB+dex,结果包括阿片类药物消耗,VAS得分,满意度和阻断持续时间.
主要成果:
- 在LB和LB+dex组之间,阿片类药物消费 (氧化或MME) 没有显著差异.
- 大约77.1%的患者没有服用阿片类药物,95.2%的处方阿片类药物未使用.
- 两组之间没有观察到VAS得分,患者满意度或阻塞持续时间的显著差异.
结论:
- 通过ACB,SSI和iPACK通过甲沙或不使用甲沙的单次射击LB提供了很好的疼痛控制和ACLR后最小的阿片类药物使用.
- 无阿片类药物的ACLR是一个现实的目标,大多数患者不需要术后麻醉剂.
- 在这项研究中,甲与单独使用LB相比,没有延长止痛时间或改变结果.
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