全膝关节置换术后疼痛管理新进展

New progress of pain management after total knee arthroplasty

背景全膝关节置换术（total knee arthroplasty,TKA）后疼痛是影响膝关节早期术后功能锻炼的主要原因,其术后镇痛对医护人员是一项具有挑战性的任务,因为它既要求有充分的镇痛,又要求对关节运动功能的影响最小,区域阻滞技术为术后疼痛管理提供了良好的方法.目的 介绍TKA术后各种区域疼痛管理的优势与风险,综述新的研究结果,为TKA术后疼痛管理提供新线索.内容股神经阻滞（femoral nerve block,FNB）为TKA术后提供有效镇痛,是否附加使用坐骨神经阻滞作为临床治疗方法还存在一定争议.腰段硬膜外阻滞可明显增加骨科患者硬膜外血肿的发生率,相比硬膜外镇痛,FNB可提供相似的术后镇痛效果及更大的满意度,同时可明显降低患者发生副作用的风险.局部浸润镇痛（local infiltration analgesia,LIA）和收肌管阻滞是有希望获得足够的疼痛控制同时具有较少副作用的新技术.趋向LIA和收肌管阻滞有可能取代FNB成为TKA术后的疼痛管理方式,但仍需要进一步的临床试验以验证目前的研究结果.

Background The postoperative pain after total knee arthroplasty （TKA） is the main reason to affect the early postoperative function exercise of the knees. Postoperative analgesia is a challenging task for medical personnel because it requires not only good analgesia effect, but also a minimal impact on joint movement function. The regional anesthesia techniques provides a good direction for the management of postoperative pain. Objective To introduce the advantages and risks of various regional pain management after TKA and review the new research advances to provide new clues for pain management after TKA. Content Femoral nerve block （FNB） provides effective postoperative analgesia for patients recovering from TKA. Whether using the sciatic nerve block additionally as the clinical treatment method or not is still in disputation. Lumbar epidnral block can obviously increase the incidence of epidural hematoma in orthopedic patients. Femoral nerve block can provide a similar effect and greater satisfaction. In the meantime, comparing with the epidural pain management, it also can obviously reduce the risk of adverse reactions occurrence. Local infiltration analgesi （LIA） and adductor canal block have hope to get enough pain control and with fewer side effects. Trend LIA management and adductor canal block may replace FNB as pain management after TKA, but it still need further clinical trials to verify current results.