人工全膝关节置换术围手术期疼痛管理现状

Pain management in perioperative period of total knee arthroplasty

人工全膝关节置换术后疼痛会显著影响患者的术后康复、延长住院时间以及降低满意度。随着对全膝关节置换术镇痛认识的提高和镇痛方案的完善,患者术后疼痛明显改善。本文由两名研究者在CNKI,CMCI,万方数据,Pubmed,EBSCO中完成了文献检索,最终有85篇文章被纳入,对当前人工全膝关节置换术围手术期常见的疼痛管理方案及现状做一综述。结果显示,疼痛管理最早起于术前超前镇痛,贯穿于包括麻醉、手术操作、术后管理在内的全部治疗过程中。多模式镇痛方案逐渐取代单一镇痛方案已是大势所趋。本文通过对人工全膝关节置换术后镇痛方案的总结,为骨科医生全膝关节置换术后镇痛提供借鉴,更好地进行围手术期的疼痛管理,从而使患者能够在术后获得更低的疼痛评分,加速术后康复,提高手术满意度。

Pain after total knee arthroplasty （TKA） can significantly affect the postoperative rehabilitation of patients, prolong the length of hospital stay, and reduce the degree of satisfaction. With the increasing understanding of analgesia and the development of analgesic regimen in TKA, the postoperative pain of patients is relieved significantly. A literature search was performed by two researchers in CNKI, CMCI, Wanfang Data, PubMed, and EBSCO. A total of 85 articles were included. The current situation of pain management in the perioperative period of TKA is reviewed. It is shown that pain management starts with preemptive analgesia and exists throughout the whole treatment, including anesthesia, surgical operation, and postoperative management. Muhimodal analgesic regimen gradually replaces single analgesic regimen and represents the general trend. This paper summarizes the analgesic regimen after TKA and provides a reference for orthopaedic surgeons to improve the periopera- tire pain management. Therefore patients will have lower pain score after TKA, accelerated postoperative rehabilitation, and in- creased degree of satisfaction with the surgery.