全膝关节置换患者围术期疼痛控制

Pain Management for Total Knee Arthroplasty Pain Management for Total Knee Arthroplasty

人工全膝关节置换术后患者通常都会经历明显的术后疼痛,这种疼痛限制了患者的早期康复。有效的镇痛方法可以缓解患者的术后疼痛,使患者能积极主动进行早期功能锻炼。近年来,出现越来越多的多模式疼痛控制方案,这些新的疼痛控制方案可能包括如下一种或多种模式：口服消炎止痛药;连续硬膜外麻醉;单次剂量脊髓和（或）硬膜外吗啡注射;局麻药,吗啡和（或）类固醇混合物关节囊周围注射;外周神经阻滞。通过局部麻醉和多模式疼痛控制方案,在尽可能避免不必要的使用麻醉剂情况下,达到无痛性全膝关节置换。本文主要就今年来出现的多模式的术后镇痛方案予以综述。

The introduction of Total Knee Arthroplasty has significant improved the quality of life of people with degenerative joint disease of knee. But patients undergoing total knee arthroplasty typically experience significant postoperative pain that can limit their early rehabilitation. Providing for adequate analgesia leads to the ability of patients to begin physical therapy earlier and be more aggressive, and, as a result, experience a more rapid recovery. Today, the emergence of a growing number of multi-modal pain control programs, which involve not only peripheral but also central analgesic analgesic. Pain control of these new programs may include one or more of the following modes ： administration of anti-inflammatories ; continuous epidural anesthesia ; single dose spinal and/or epidural opioid injections; periarticular capsular injections with a combination of local anesthetics, opioids, and/or steroids; and finally the use of peripheral nerve blocks. Through multi-modal local anesthesia and pain control program,in as much as possible to avoid unnecessary use of narcotic eases, to achieve painless total knee replacement. This article appeared on this year＇s multi-medal program of postoperative analgesia Review.