关节腔周围注射在全膝关节置换术后的镇痛应用

静 安(承德医学院附属医院，中国)
树凯 李(承德医学院附属医院，中国)
志学 王(承德医学院附属医院，中国)

摘要

关节腔周围注射又称关节腔局部浸润镇痛或鸡尾酒疗法，是新兴起的用于全膝关节置换术后的镇痛方式，全膝关节置换术后往往伴随剧烈疼痛，患者术后镇痛不佳，可能会导致严重术后并发症，增加患者住院时间并延后患者术后功能锻炼及运动恢复，关节腔周围注射在全膝关节置换术后的应用可以起到很好的镇痛效果，并节省阿片类药物的使用，缩短住院时间，减少住院支出，且不影响手术切口愈合、股四头肌肌力，不增加感染风险，相对避免了神经阻滞的潜在并发症，目前已经成为TKA术后镇痛的新趋势，随着该技术应用的日益增加，根据其使用，对该项技术的镇痛效果认识也日益提升。

关键词

关节周围注射；局部浸润镇痛；鸡尾酒疗法；全膝关节置换术

参考

Aso K, Izumi M, Sugimura N, et al. Additional benefit of local infiltration of analgesia to femoral nerve block in total knee arthroplasty: double-blind randomized control study[J]. Knee Surg Sports Traumatol Arthrosc, 2019(27):2368-2374.

Seo SS, Kim OG, Seo JH, Kim DH, Kim YG, Park BY. Comparison of the effect of continuous femoral nerve block and adductor canal block after primary total knee arthroplasty[J]. Clin Orthop Surg, 2017(9):303-309.

J.E. Paul, A. Arya, L. Hurlburt, J. Cheng, Femoral nerve block improves analgesia outcomes after total knee arthroplasty: a meta-analysis of randomized controlled trials[J]. Anesthesiology, 2010(113):1144e62.

A. Hadzic, T.T. Houle, X. Capdevila, B.M. Ilfeld, Femoral nerve block for analgesia in patients having knee arthroplasty[J]. Anesthesiology,2010(113):1014e5.

P. Essving, K. Axelsson, J. Kjellberg, O. Wallgren, A. Gupta, A. Lundin, Reduced hospital stay, morphine consumption, and pain intensity with local infiltration analgesia after unicompartmental knee arthroplasty[J]. Acta Orthop,2009(80):213219.

K.R. Tripuraneni, S.T. Woolson, N.J. Giori, Local infiltration analgesia in TKA patients reduces length of stay and postoperative pain scores[J]. Orthopedics,2011(34):173.

S.X. Li, X.M. Luo, P. Wang, H. Sun, K. Wang, X.L. Sun, Clinical outcomes of gap balancing vs measured resection in total knee arthroplasty: a systematic review and meta-analysis involving 2259 subjects[J]. Arthroplast,2018(33):2684-2693.

YaDeau, J. T. Is Local Infiltration Analgesia the Preferred Analgesic Approach for Total Knee Arthroplasty?[J]. Journal of Bone and Joint Surgery,2023(3):105.

魏小伍,梁亚霞,汤瑞昌.轻比重罗哌卡因单侧腰麻-硬膜外联合麻醉在高龄髋关节置换术中的应用[J].中华实用诊断与治疗杂志,2010,24(2):173-174.

Liu, Q., A. Wang and J. Zhang. The effects of local infiltration anesthesia and femoral nerve block analgesia after total knee arthroplasty: a systematic review and meta-analysis[J]. Ann Transl Med,2022,10(4):78.

P. Jaeger, D. Zaric, J.S. Fomsgaard, et al., Adductor canal block versus femoral nerve block for analgesia after total knee arthroplasty: a randomized, double-blind study, Reg[J]. Anesth. Pain Med,2013(38):526-532.

Narayan, P., V. A. Sahitya, M. M. et al. Comparison between Local Infiltration Analgesia and Ultrasound Guided Single Shot Adductor Canal Block Post Total Knee Replacement Surgery-A Randomized Controlled Trial[J]. Anesth Essays Res,2021,15(1):32-37.

DOI: http://dx.doi.org/10.12345/yzlcyxzz.v7i3.16231