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中华关节外科杂志(电子版) ›› 2024, Vol. 18 ›› Issue (04) : 517 -523. doi: 10.3877/cma.j.issn.1674-134X.2024.04.011

综述

超前镇痛在全膝关节置换术中的研究进展
许亚龙1, 巩栋2, 陈晓涛2,()   
  1. 1. 810016 西宁,青海大学
    2. 810007 西宁,青海省人民医院
  • 收稿日期:2024-01-03 出版日期:2024-08-01
  • 通信作者: 陈晓涛
  • 基金资助:
    青海省卫健委指导性计划项目(2023-wjzdx-08)

Research progress on advanced analgesia in total knee replacement surgery

Yalong Xu1, Dong Gong2, Xiaotao Chen2,()   

  1. 1. Qinghai university, Xining 810016, China
    2. Qinghai Provincial People's Hospital, Xining 810007, China
  • Received:2024-01-03 Published:2024-08-01
  • Corresponding author: Xiaotao Chen
引用本文:

许亚龙, 巩栋, 陈晓涛. 超前镇痛在全膝关节置换术中的研究进展[J]. 中华关节外科杂志(电子版), 2024, 18(04): 517-523.

Yalong Xu, Dong Gong, Xiaotao Chen. Research progress on advanced analgesia in total knee replacement surgery[J]. Chinese Journal of Joint Surgery(Electronic Edition), 2024, 18(04): 517-523.

全膝关节置换术(TKA)被认为是终末期膝关节炎患者的一种经济有效的治疗方法。同时,TKA被认为是最痛苦的骨科手术之一。TKA术后疼痛控制仍然是一项具有挑战性的任务。许多止痛药的创新被用来减少疼痛的水平,但到目前为止,没有一个被证明是最佳选择。多模式超前镇痛包括使用具有不同作用机制的镇痛辅助剂,以加强术后疼痛管理。该入路是一种较好的减轻术后疼痛方法,副作用小。本综述的目的是讨论当前TKA术后疼痛管理方案。研究者对文献的回顾表明,多模式镇痛被认为是TKA围手术期疼痛管理的最佳方案,并通过多种类型的药物和给药途径的组合改善了临床结局和患者满意度,包括超前镇痛、轴索麻醉、外周神经阻滞、患者自控镇痛和局部浸润镇痛以及口服阿片类/非阿片类药物。多模式镇痛可提供上级疼痛缓解,促进膝关节恢复,并减少接受TKA的患者的阿片类药物消耗和相关不良反应。

For patients with end-stage knee osteoarthritis, total knee replacement is thought to be a financially sensible course of treatment. However, total knee replacement is regarded as one of the most excruciating orthopedic procedures. Controlling pain after complete knee replacement surgery is still a challenging effort. Although a lot of analgesic inventions have been utilized torelieve pain, none of them have shown to be the best choice so far. Using analgesic adjuvants with several modes of action to improve postoperative pain control is known as multimodal hyperalgesia. With less adverse effects, this access offers a more effective way to lessen postoperative pain. This review aimed to go over the most recent postoperative pain management procedures for total knee replacements. According to this review of the literature, multimodal analgesia which combines a number of different medication types and delivery methods (such as oral opioid/nonopioid medications, supramodal analgesia, axonal anesthesia, peripheral nerve blocks, patient-controlled analgesia, and local infiltration analgesia) is thought to be the best option for perioperative pain management in total knee arthroplasty. It also improves clinical outcomes and patient satisfaction. For patients undergoing complete knee replacement, multimodal analgesia minimizes opioid usage and its negative consequences while improving pain relief and speeding knee healing.

[1]
罗瑞,郭宇峰,张利佳,等. 舒芬太尼联合酮咯酸氨丁三醇超前镇痛用于骨科患者术后镇痛中的价值分析[J]. 山西医药杂志2020,49(1):36-37.
[2]
Ssamy ACPatro BPJeyaraman M,etal. Evaluation of pre-emptive analgesia in total knee arthroplasty during early post-operative periods[J/OL]. Cureus2023,15(7):e41433. DOI: 10.7759/cureus.41433.
[3]
夏玉雪,乔远静,李丹丹,等. 超前镇痛理念的应用研究进展[J]. 护理研究2022,36(10):1831-1834.
[4]
Byrne KSmith C. Preemptive analgesia: an unobtainable goal?[J]. J Cardiothorac Vasc Anesth2019,33(2):460-461.
[5]
Szedlák BMitre CFülesdi B. Preemptive and preventive analgesia - an important element in perioperative pain management[J]. Orv Hetil2018,159(17):655-660.
[6]
Blikman TRienstra Wvan Raaij TM,et al. Duloxetine in OsteoArthritis(DOA)study: study protocol of a pragmatic open-label randomised controlled trial assessing the effect of preoperative pain treatment on postoperative outcome after total hip or knee arthroplasty[J/OL]. BMJ Open2016,6(3):e010343. DOI: 10.1136/bmjopen-2015-010343.
[7]
Small CLaycock H. Acute postoperative pain management[J/OL]. Br J Surg2020,107(2):e70-e80. DOI: 10.1002/bjs.11477.
[8]
Bell A. The neurobiology of acute pain[J]. Vet J2018,237:55-62.
[9]
Sun WHChen CC. Roles of proton-sensing receptors in the transition from acute to chronic pain[J]. J Dent Res2016,95(2):135-142.
[10]
Oputa TJJain N. Acute knee pain[J/OL]. BMJ2023,382:e075577. DOI: 10.1136/bmj-2023-075577.
[11]
Mears LMears J. The pathophysiology,assessment,and management of acute pain[J]. Br J Nurs2023,32(2):58-65.
[12]
Mackintosh-Franklin C. Recognising and assessing acute pain[J]. Nurs Stand2021,36(4):61-66.
[13]
Memtsoudis SGCozowicz CBekeris J,et al. Peripheral nerve block anesthesia/analgesia for patients undergoing primary hip and knee arthroplasty: recommendations from the International Consensus on Anesthesia-Related Outcomes after Surgery(ICAROS)group based on a systematic review and meta-analysis of current literature[J]. Reg Anesth Pain Med2021,46(11):971-985.
[14]
Tong SXLi RSWang D,et al. Artificial intelligence technology and ultrasound-guided nerve block for analgesia in total knee arthroplasty[J]. World J Clin Cases2023,11(29):7026-7033.
[15]
de Arzuaga CISMiguel MBiarnés A,et al. Single-injection nerve blocks for total knee arthroplasty: femoral nerve block versus femoral triangle block versus adductor canal block-a randomized controlled double-blinded trial[J]. Arch Orthop Trauma Surg2023,143(11):6763-6771.
[16]
Nicolino TICostantini JCarbó L. Complementary saphenous nerve block to intra-articular analgesia reduces pain after total knee arthroplasty: aprospective randomized controlled trial[J]. J Arthroplasty2020,35(6S):S168-S172.
[17]
Kim SEHan HSLee MC,et al. Single shot adductor canal block combined with intravenous patient-controlled analgesia can be effective as continuous adductor canal block in reducing opioid consumption and breakthrough pain after total knee arthroplasty[J/OL]. J Exp Orthop2022,9:84. DOI: 10.1186/s40634-22-00523-6.
[18]
王鑫光,侯毅,李杨,等. 不同股神经阻滞对全膝关节置换术后疼痛和肌力的影响[J/CD]. 中华关节外科杂志(电子版)2022,16(4):425-430.
[19]
Wang QZhao CHu J,et al. Efficacy of a modified cocktail for periarticular local infiltration analgesia in total knee arthroplasty: a prospective,double-blinded,randomized controlled trial[J]. J Bone Joint Surg Am2023,105(5):354-362.
[20]
Moreno ITsamassiottis SEttinger M,et al. Femoral nerve blockade versus local infiltration analgesia for primary knee arthroplasty. Randomised controlled trial[J]. Anaesthesiol Intensive Ther2022,54(5):387-392.
[21]
Li WTBell KLYayac M,et al. A postdischarge multimodal pain management cocktail following total knee arthroplasty reduces opioid consumption in the 30-day postoperative period: a group-randomized trial[J]. J Arthroplasty2021,36(1):164-172.e2.
[22]
邸申,黄健. 人工全膝关节置换术中应用“鸡尾酒” 疗法的研究进展[J]. 中国药物与临床2022,22(2):188-192.
[23]
Gupta KChawla PASharma D. Synthetic strategies towards safer NSAIDs through prodrug approach: areview[J]. Mini Rev Med Chem2021,21(15):2065-2102.
[24]
Wang QMa TWang L,et al. Efficacy of adding acetaminophen to preemptive multimodal analgesia in total knee arthroplasty: adouble-blinded randomized study[J]. Orthop Surg2023,15(9):2283-2290.
[25]
Qureshi IAbdulrashid KThomas SH,et al. Comparison of intravenous paracetamol(acetaminophen)to intravenously or intramuscularly administered non-steroidal anti-inflammatory drugs(NSAIDs)or opioids for patients presenting with moderate to severe acute pain conditions to the ED: systematic review and meta-analysis[J]. Emerg Med J2023,40(7):499-508.
[26]
蓝沁舟,方芳,仓静. 阿片类药物及其使用的新进展[J]. 中国临床医学2023,30(4):736-742.
[27]
Wang QZhang WXiao T,et al. Efficacy of opioids in preemptive multimodal analgesia for total knee arthroplasty: aprospective,double-blind,placebo-controlled,randomized trial[J]. J Arthroplasty2023,38(1):65-71.
[28]
YaDeau JTMayman DJJules-Elysee KM,et al. Effect of duloxetine on opioid use and pain after total knee arthroplasty: atriple-blinded randomized controlled trial[J]. J Arthroplasty2022,37(6S):S147-S154.
[29]
Kim TZhou CESara RA,et al. The effect of perioperative sustained-release opioid use on long-term opioid dispensing following total knee arthroplasty: a retrospective cohort study[J]. N Z Med J2021,134(1544):57-68.
[30]
Hannon CPFillingham YAGililland JM,etal. A systematic review of the efficacy and safety of ketamine in total joint arthroplasty[J]. J Arthroplasty2023,38(4):763-768.e2.
[31]
King MR, Ladha KS, Gelineau AM, et al. Perioperative dextromethorphan as an adjunct for postoperative pain[J]. Anesthesiology, 2016, 124(3): 696-705.
[32]
焦瑞. 依托考昔超前镇痛联合地塞米松促进全膝关节置换术后早期康复的研究[D]. 扬州: 扬州大学,2020.
[33]
Passias BJJohnson DBSchuette HB,et al. Preemptive multimodal analgesia and post-operative pain outcomes in total hip and total knee arthroplasty[J]. Arch Orthop Trauma Surg2023,143(5):2401-2407.
[34]
Zhou YLiu XDing C,et al. Positive preemptive analgesia effectiveness of pregabalin combined with celecoxib in total knee arthroplasty: aprospective controlled randomized study[J/OL]. Pain Res Manag2023,2023:7088004. DOI: 10.1155/2023/7088004.
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