中国全膝关节置换术围手术期疼痛管理指南(2022)

Guidelines for Perioperative Pain Management in Total Knee Arthroplasty in China(2022)

全膝关节置换术(total knee arthroplasty,TKA)是目前治疗终末期膝关节疾病的主要方法。TKA术后常伴有中度至重度的疼痛,严重影响患者术后康复、患者满意度和总体疗效。多模式镇痛被认为是缓解TKA术后疼痛的理想方案。目前尚无TKA围手术期疼痛管理指南。经中华医学会骨科学分会关节外科学组、北京医学会骨科专业委员会关节外科学组批准及专家讨论,采用推荐意见的分级评估、制定及评价方法及国际实践指南报告规范,遴选出最为关注的20个临床问题,通过证据检索、证据质量评价及确立推荐意见和强度,采用德尔菲法进行4轮函询,最终形成20条推荐意见。本指南的制定旨在提高TKA围手术期疼痛管理的规范化和标准化。

Total knee arthroplasty(TKA)is currently the main treatment for end-stage knee disease.Moderate to severe pain often occurs after TKA,which seriously affects postoperative rehabilitation,patient satisfaction and overall outcome.Multimodal analgesia is considered as the ideal solution.There is no guideline for perioperative pain management in TKA in China.On the basis of the discussions by experts from Joint Surgery Branch of Chinese Orthopaedic Association and Joint Surgery Branch of Beijing Orthopaedic Association,the Grading of Recommendations Assessment,Development,and Evaluation(GRADE)approach was used to rate the quality of evidence and the strength of recommendations.Reporting Items for Practice Guidelines in Healthcare(RIGHT)checklist was strictly followed to report the guideline.Finally,20 evidence-based recommendations were formulated based on the 20 most concerning clinical problems among orthopaedic surgeons according to evidence retrieval,quality evaluation of body evidence,and establishment of direction and intensity of recommendations through four rounds of Delphi surveys.This guideline was developed to improve the standardization of perioperative pain management in TKA in China.