人工全膝关节置换围术期镇痛方法:多模式方案及最佳疼痛管理

Perioperative analgesia in total knee replacement: multimodal analgesia schemes and optimal pain management

背景:积极的人工全膝关节置换围手术期镇痛可以加快关节功能康复,减少置换后并发症,并提高患者对全膝关节置换技术的整体评价。目的:对全膝关节置换围术期中一些常用的镇痛药物和镇痛方法予以简要论述。方法:计算机检索万方数据库以及PubMed数据库1994年至2014年期间有关人工全膝关节置换围术期镇痛方面的文章。中文检索词为"全膝关节置换,硬膜外镇痛、周围神经阻滞、关节局部镇痛、自控镇痛、冷疗",英文检索词为"total knee replacement,epidural analgesia,peripheral nerve block,joint local analgesia,patient controlled analgesia,cold treatment"。结果与结论:初检得到986篇文献,最终纳入文章55篇。随着对全膝关节置换、早期功能康复及置换后疼痛控制的关注,最近有关镇痛药物、镇痛方案的文献大量涌现。镇痛药物包括阿片类药物、非类固醇类抗炎药、局麻药、N-甲基-D-门冬氨酸受体阻滞剂等,镇痛方案包括硬膜外镇痛、周围神经阻滞、关节局部镇痛、患者自控镇痛、冷疗镇痛等。各种镇痛药物和方法各有优缺点,目前多模式镇痛方案已为大家认可,但有关最佳疼痛管理的方案仍然存在争议,对于这些镇痛方式,应权衡利弊,依据患者个体特征以及现有的技术基础综合考虑。

BACKGROUND：Positive treatment of perioperative analgesia after total knee arthroplasty can accelerate recovery of joint function, reduce complications after replacement, and improve overal technical evaluation of total knee arthroplasty. OBJECTIVE：To summarize commonly used analgesic drugs and analgesia method of total knee arthroplasty. METHODS：A computer-based online research of Wanfang database and PubMed database was performed to col ect articles published between 1994 and 2014 with the keywords of“total knee replacement, epidural analgesia, peripheral nerve block, joint local analgesia, patient control ed analgesia, cold treatment”in Chinese and English. RESULTS AND CONCLUSION：There were 986 articles after the initial survey. Final y, 55 articles were included according to the inclusion and exclusion criteria. As the technology for total knee arthroplasty, early functional rehabilitation and replacement of pain control has been widely concerned, a large number of literatures about analgesic drugs and analgesic programs emerge. Analgesic drugs include opioids, non-steroidal anti-inflammatory drugs, local anesthetics and N-methyl-aspartate receptor blockers. Analgesic program includes epidural analgesia, peripheral nerve blockage, joint local analgesia, patient-control ed analgesia and cold therapy. These analgesic drugs and methods have their advantages and disadvantages. At present, multimodal analgesia schemes have been recognized, but the optimal pain management scheme remains controversial. Increasing considerations should be paid on the choice of analgesic methods, depending on individual characteristics and existing technology.