全膝关节置换术的围手术期镇痛研究进展
Progress in the Research of Perioperative Analgesia in Total Knee Replacement
DOI: 10.12677/ACM.2023.133668, PDF,   
作者: 孟 璐, 张二飞：延安大学附属医院麻醉科，陕西 延安
关键词: 关节置换；全膝关节置换；镇痛；神经阻滞；综述；Joint Replacement； Total Knee Replacement； Analgesia； Nerve Block； Review
摘要: 传统的全膝关节置换术与严重的术后疼痛相关，在接受TKA的患者中，60%经历了严重的术后膝关节疼痛，30%经历了中度疼痛，这可能会限制恢复和延长住院时间。目前许多医院正在为接受关节置换术(TKA)的患者实施门诊和短期住院计划。有效充分的围手术期镇痛是门诊关节置换术成功的关键，因此，我们有必要充分了解目前TKA的麻醉镇痛方案，以期改善患者的预后。本文就目前现有文献研究，为单侧初次全膝关节置换围手术期的最佳疼痛处理提出分析建议。
Abstract: Traditional total knee replacement is associated with severe postoperative pain, with 60% of pa-tients receiving TKA experiencing severe postoperative knee pain and 30% experiencing moderate pain, which can limit recovery and prolong hospital stays. Many hospitals are currently implement-ing outpatient and short-term inpatient programs for patients undergoing total joint replacement (TKA). Effective and adequate perioperative analgesia is the key to the success of outpatient joint arthroplasty. Therefore, it is necessary to fully understand the current anesthesia and analgesia protocol of TKA in order to improve the prognosis of patients. Based on the current literature, this paper proposes suggestions for the optimal pain management in perioperative period of unilateral primary total knee replacement.
文章引用：孟璐, 张二飞. 全膝关节置换术的围手术期镇痛研究进展[J]. 临床医学进展, 2023, 13(3): 4656-4662. https://doi.org/10.12677/ACM.2023.133668

参考文献

[1] Philips, W.J. and Currier, B.L. (2004) Analgesic Pharmacology: I. Neuro-Physiology. Journal of the American Academy of Orthopaedic Surgeons, 12, 213-220. [Google Scholar] [CrossRef] [PubMed]
[2] Affney, C.J., Pelt, C.E., Gililland, J., et al. (2017) Perioperative Pain Management in Hip and Knee Arthroplasty. Orthopedic Clinics of North America, 48, 407-419. [Google Scholar] [CrossRef] [PubMed]
[3] Joshi, G.P. and Ogunnaike, B.O. (2005) Consequences of Inadequate Postoperative Pain Relief and Chronic Persistent Postoperative Pain. Anesthesiology Clinics of North America, 23, 21-36. [Google Scholar] [CrossRef] [PubMed]
[4] Pogatzki-Zahn, E.M. and Zahn, P.K. (2006) From Preemptive to Preventive Analgesia. Current Opinion in Anesthesiology, 19, 551-555. [Google Scholar] [CrossRef] [PubMed]
[5] Grape, S. and Tramèr, M.R. (2007) Do We Need Preemptive Analgesia for the Treatment of Postoperative Pain? Best Practice & Research Clinical Anaesthesiology, 21, 51-63. [Google Scholar] [CrossRef] [PubMed]
[6] American Society of Anesthesiologists Task Force on Acute Pain Management (2012) Practice Guidelines for Acute Pain Management in the Perioperative Setting: An Updated Re-port by the American Society of Anesthesiologists Task Force on Acute Pain Management. Anesthesiology, 116, 248-273. [Google Scholar] [CrossRef] 
[7] Du, X. and Gu, J. (2018) The Efficacy and Safety of Parecoxib for Reducing Pain and Opioid Consumption Following Total Knee Arthroplasty: A Meta-Analysis of Ran-domized Controlled Trials. International Journal of Surgery, 59, 67-74. [Google Scholar] [CrossRef] [PubMed]
[8] Fillingham, Y.A., Hannon, C.P., Roberts, K.C., Mullen, K., et al. (2020) The Efficacy and Safety of Nonsteroidal Anti-Inflammatory Drugs in Total Joint Arthroplasty: Systematic Review and Direct Meta-Analysis. The Journal of Arthroplasty, 35, 2739-2758. [Google Scholar] [CrossRef] [PubMed]
[9] Munteanu, A.M., Cionac Florescu, S., Anastase, D.M., et al. (2016) Is There Any Analgesic Benefit from Preoperative vs. Postoperative Administration of Etoricoxib in Total Knee Arthro-plasty under Spinal Anaesthesia? A Randomised Double-Blind Placebo-Controlled Trial. European Journal of Anaesthe-siology, 33, 840-845. [Google Scholar] [CrossRef] 
[10] Zhu, Y.Z., Yao, R., Zhang, Z., et al. (2016) Parecoxib Pre-vents Early Postoperative Cognitive Dysfunction in Elderly Patients Undergoing Total Knee Arthroplasty: A Dou-ble-Blind, Randomized Clinical Consort Study. Medicine (Baltimore), 95, e4082. [Google Scholar] [CrossRef] 
[11] Zhu, Y., Yao, R., Li, Y., et al. (2018) Protective Effect of Celecoxib on Early Postoperative Cognitive Dysfunction in Geriatric Patients. Frontiers in Neurology, 9, 633. [Google Scholar] [CrossRef] [PubMed]
[12] Buvanendran, A., Kroin, J.S., Della Valle, C.J., et al. (2010) Peri-operative Oral Pregabalin Reduces Chronic Pain after Total Knee Arthroplasty: A Prospective, Randomized, Controlled Trial. Anesthesia & Analgesia, 110, 199-207. [Google Scholar] [CrossRef] 
[13] 赵旻暐, 王宁, 曾琳, 李民, 赵中凯, 张菡, 田华. 膝关节置换术后连续收肌管阻滞与股神经阻滞的疗效比较[J]. 北京大学学报(医学版), 2017, 49(1): 142-147.
[14] Lund, J., Jenstrup, M.T., Jaeger, P., et al. (2011) Continuous Adductor-Canal-Blockade for Adjuvant Post-Operative Analgesia after Major Knee Surgery: Preliminary Results. Acta Anaesthesiologica Scandinavica, 55, 14-19. [Google Scholar] [CrossRef] [PubMed]
[15] Jenstrup, M.T., Jæger, P., Lund, J., et al. (2012) Effects of Adductor-Canal-Blockade on Pain and Ambulation after Total Knee Arthroplasty: A Randomized Study. Acta Anaesthe-siologica Scandinavica, 56, 357-364. [Google Scholar] [CrossRef] [PubMed]
[16] Sharma, S., Iorio, R., Specht, L.M., et al. (2010) Complica-tions of Femoral Nerve Block for Total Knee Arthroplasty. Clinical Orthopaedics and Related Research, 468, 135-140. [Google Scholar] [CrossRef] [PubMed]
[17] Chan, E.Y., Fransen, M., Parker, D.A., et al. (2014) Femoral Nerve Blocks for Acute Postoperative Pain after Knee Replacement Surgery. Cochrane Database of Systematic Reviews, 5, CD009941. [Google Scholar] [CrossRef] 
[18] Seet, E., Leong, W.L., Yeo, A.S., et al. (2006) Effective-ness of 3-in-1 Continuous Femoral Block of Differing Concentrations Compared to Patient Controlled Intravenous Mor-phine for Post Total Knee Arthroplasty Analgesia and Knee Rehabilitation. Anaesthesia and Intensive Care, 34, 25-30. [Google Scholar] [CrossRef] 
[19] Memtsoudis, S.G., Danninger, T., Rasul, R., et al. (2014) In-patient Falls after Total Knee Arthroplasty: The Role of Anesthesia Type and Peripheral Nerve Blocks. Anesthesiology, 120, 551-563. [Google Scholar] [CrossRef] 
[20] Li, D., Yang, Z., Xie, X., Zhao, J. and Kang, P. (2016) Adductor Canal Block Provides Better Performance after Total Knee Arthroplasty Compared with Femoral Nerve Block: A Systematic Review and Meta-Analysis. International Orthopaedics, 40, 925-933. [Google Scholar] [CrossRef] [PubMed]
[21] Gao, F., Ma, J., Sun, W., et al. (2017) Adductor Canal Block versus Femoral Nerve Block for Analgesia after Total Knee Arthroplasty: A Systematic Review and Meta-Analysis. The Clinical Journal of Pain, 33, 356-368. [Google Scholar] [CrossRef] 
[22] Fillingham, Y.A., Hannon, C.P., Kopp, S.L., et al. (2022) The Efficacy and Safety of Regional Nerve Blocks in Total Knee Arthroplasty: Systematic Review and Direct Me-ta-Analysis. Journal of Arthroplasty, 37, 1906-1921.e2. [Google Scholar] [CrossRef] [PubMed]
[23] Sercia, Q.P., Bergeron, J.J., Pelet, S., et al. (2022) Continuous vs. Single-Shot Adductor Canal Block for Pain Management Following Primary Total Knee Arthroplasty: A Systematic Re-view and Meta-Analysis of Randomized Controlled Trials. Orthopaedics & Traumatology, Surgery & Research: OTSR, 108, Article ID: 103290. [Google Scholar] [CrossRef] [PubMed]
[24] Abdallah, F.W., Chan, V.W.S., Gandhi, R., et al. (2014) The An-algesic Effects of Proximal, Distal, or No Sciatic Nerve Block on Posterior Knee Pain after Total Knee Arthroplasty: A Double-Blind Placebo-Controlled Randomized Trial. Anesthesiology, 121, 1302-1310. [Google Scholar] [CrossRef] 
[25] Abdallah, F.W. and Brull, R. (2011) Is Sciatic Nerve Block Advantageous When Combined with Femoral Nerve Block for Postoperative Analgesia Following Total Knee Arthro-plasty? A Systematic Review. Regional Anesthesia & Pain Medicine, 36, 493-498. [Google Scholar] [CrossRef] 
[26] Elliot, C.E. and Thobhani, S. (2014) The Adductor Canal Catheter and Interspace between Popliteal Artery and Posterior Capsule of the Knee for Total Knee Arthroplasty. Region-al Anesthesia and Pain Management, 18, 126-129. [Google Scholar] [CrossRef] 
[27] VanderWielen, B.A., Fitzsimmons, A.J., Kovacs, A.J., et al. (2020) Community Hospital Implementation of the IPACK Block Reduces Opioid Use and Length of Stay after Total Knee Ar-throplasty. Journal of Clinical Anesthesia, 65, Article ID: 109857. [Google Scholar] [CrossRef] [PubMed]
[28] Kampitak, W., Tanavalee, A., Ngarmukos, S., et al. (2020) Motor-Sparing Effect of iPACK (Interspace between the Popliteal Artery and Capsule of the Posterior Knee) Block ver-sus Tibial Nerve Block after Total Knee Arthroplasty: A Randomized Controlled Trial. Regional Anesthesia & Pain Med-icine, 45, 267-276. [Google Scholar] [CrossRef] [PubMed]
[29] Block, B.M., Liu, S.S., Rowlingson, A.J., et al. (2003) Efficacy of Postoperative Epidural Analgesia: A Meta-Analysis. JAMA, 290, 2455-2463. [Google Scholar] [CrossRef] [PubMed]
[30] Li, C., Qu, J., Pan, S. and Qu, Y. (2018) Local Infiltration Anesthe-sia versus Epidural Analgesia for Postoperative Pain Control in Total Knee Arthroplasty: A Systematic Review and Me-ta-Analysis. Journal of Orthopaedic Surgery and Research, 13, 112. [Google Scholar] [CrossRef] [PubMed]
[31] Fowler, S.J., Symons, J., Sabato, S. and Myles, P.S. (2008) Epi-dural Analgesia Compared with Peripheral Nerve Blockade after Major Knee Surgery: A Systematic Review and Me-ta-Analysis of Randomized Trials. British Journal of Anaesthesia, 100, 154-164. [Google Scholar] [CrossRef] [PubMed]
[32] Rantasalo, M.T., Palanne, R., Juutilainen, K., et al. (2018) Randomised Controlled Study Comparing General and Spinal Anaesthesia with and without a Tourniquet on the Outcomes of Total Knee Arthroplasty: Study Protocol. BMJ Open, 8, e025546. [Google Scholar] [CrossRef] [PubMed]
[33] Ryu, J.H., Jeon, Y.T., Min, B., et al. (2018) Effects of Palonosetron for Prophylaxis of Postoperative Nausea and Vomiting in High-Risk Patients Undergoing Total Knee Ar-throplasty: A Prospective, Randomized, Double-Blind, Placebo-Controlled Study. PLOS ONE, 13, e0196388. [Google Scholar] [CrossRef] [PubMed]
[34] Parvataneni, H.K., Shah, V.P., Howard, H., et al. (2007) Con-trolling Pain after Total Hip and Knee Arthroplasty Using a Multimodal Protocol with Local Periarticular Injections: A Prospective Randomized Study. The Journal of Arthroplasty, 22, 33-38. [Google Scholar] [CrossRef] [PubMed]
[35] NICE (2020) Evidence Review for Anaesthesia for Knee Replace-ment. Nice Guideline NG 1517. June 2020. National Institute for Health and Care Excellence.
[36] 李俊, 李智平. 脂质体布比卡因减少全膝关节置换术后疼痛有效性的meta分析[J]. 中华骨与关节外科杂志, 2019, 12(4): 285-289.
[37] Bagsby, D.T., Ireland, P.H. and Meneghini, R.M. (2014) Liposomal Bupivacaine versus Traditional Periarticular Injection for Pain Control after Total Knee Arthroplasty. The Journal of Arthroplasty, 29, 1687-1690. [Google Scholar] [CrossRef] [PubMed]
[38] Collis, P.N., Hunter, A.M., Vaughn, M.D., et al. (2015) Periarticu-lar Injection after Total Knee Arthroplasty Using Liposomal Bupivacaine vs a Modified Ranawat Suspension: A Prospec-tive, Randomized Study. The Journal of Arthroplasty, 31, 633-636.
[39] Ni, S.H., Jiang, W.T., Guo, L., et al. (2015) Cryotherapy on Postoperative Rehabilitation of Joint Arthroplasty. Knee Surgery, Sports Traumatology, Arthroscopy, 23, 3354-3361. [Google Scholar] [CrossRef] [PubMed]
[40] Schroder, D. and Passler, H.H. (1994) Combination of Cold and Compression after Knee Surgery: A Prospective Randomized Study. Knee Surgery, Sports Traumatology, Arthroscopy, 3, 158. [Google Scholar] [CrossRef] 

为你推荐