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中华关节外科杂志(电子版) ›› 2020, Vol. 14 ›› Issue (04) : 486 -490. doi: 10.3877/cma.j.issn.1674-134X.2020.04.016

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综述

全膝关节置换术后镇痛应用外周神经阻滞的进展
王波1, 董补怀1,()   
  1. 1. 710000 西安交通大学附属红会医院
  • 收稿日期:2019-02-22 出版日期:2020-08-01
  • 通信作者: 董补怀

Progress of peripheral nerve block in analgesic management after total knee arthroplasty

Bo Wang1, Buhua Dong1,()   

  1. 1. Department of Osteonecrosis & Joint Reconstruction Surgery, HongHui Hospital, Xi’an Jiaotong University, Xi’an 710000, China
  • Received:2019-02-22 Published:2020-08-01
  • Corresponding author: Buhua Dong
  • About author:
    Corresponding author: Dong Buhuai, Email:
引用本文:

王波, 董补怀. 全膝关节置换术后镇痛应用外周神经阻滞的进展[J/OL]. 中华关节外科杂志(电子版), 2020, 14(04): 486-490.

Bo Wang, Buhua Dong. Progress of peripheral nerve block in analgesic management after total knee arthroplasty[J/OL]. Chinese Journal of Joint Surgery(Electronic Edition), 2020, 14(04): 486-490.

全膝关节置换术(TKA)是膝关节终末期骨关节炎或类风湿性关节炎的最有效治疗方法,而术后疼痛是影响功能重建的重要因素,多模式镇痛可以给TKA患者术后提供"舒适"的康复环境。其中,外周神经阻滞是多模式镇痛的重要组成,常用的外周神经阻滞方式包括股神经阻滞、闭孔神经阻滞、坐骨神经阻滞、内收肌管阻滞、关节周围局部浸润麻醉等,这些方法具有效果确切、操作相对简单、副作用较少的优势。本综述主要检索近5年关于外周神经阻滞在TKA术后镇痛管理中的应用的国内外文献,通过比较不同阻滞方式的镇痛效果、对术后功能重建的促进作用及其副作用等,试图探索患者获益最大也最安全的术后外周神经阻滞的方法最后发现,外周神经阻滞对TKA患者术后功能康复具有良好的促进作用,并且可以明显减少镇痛药物,此外,股神经阻滞是外周神经阻滞的金标准,内收肌管阻滞是理想的替代方法。

Total knee arthroplasty (TKA) is the most effective treatment for end-stage osteoarthritis or rheumatoid arthritis of the knee. Postoperative pain is an important factor affecting functional reconstruction, and multimodal analgesia can provide a "comfortable" rehabilitation environment for TKA patients. Peripheral nerve block is an important component of multimodal analgesia, which includes femoral nerve block, adductor canal block, sciatic nerve block, obturator nerve block, local Infiltration anesthesia, and so on. The advantages of these methods are effect, relative simple procedure and less side effects. This review mainly retrieved literatures about the application of peripheral nerve block in the management of postoperative analgesia after TKA in recent five years, and tried to find out the most beneficial and safest method of peripheral nerve block after operation by comparing the analgesic effect, the promotion of functional reconstruction after operation and side effects of different blockade modes. This review found that the peripheral nerve block may play an increasing prominent role in the postoperative pain management of TKA patients, which can promote the postoperative functional rehabilitation and significantly reduce the occurrence of side effects of analgesics. In addition, femoral nerve block is the gold standard of peripheral nerve block, and adductor canal block is an ideal alternative method.

表1 外周神经阻滞在关节置换术后镇痛中的适应证及优缺点
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