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髋关节镜术后疼痛管理策略

Postoperative Pain Management Strategies in Hip Arthroscopy.

作者信息

LaPorte Collin, Rahl Michael D, Ayeni Olufemi R, Menge Travis J

机构信息

Michigan State University College of Human Medicine, Grand Rapids, MI, USA.

Division of Orthopaedic Surgery, McMaster University, Hamilton, ON, Canada.

出版信息

Curr Rev Musculoskelet Med. 2019 Dec;12(4):479-485. doi: 10.1007/s12178-019-09579-x.

Abstract

PURPOSE OF REVIEW

Hip arthroscopy is a rapidly growing field due to its significant diagnostic and therapeutic value in the management of numerous hip disorders. Adequate control of postoperative pain in patients undergoing hip arthroscopy continues to be a challenging and evolving area in orthopedics. In the absence of standardized protocols for pain management in these patients, a variety of different approaches have been utilized in an effort to find a regimen that is effective at reducing postoperative pain, narcotic consumption, and cost to the patient and healthcare system. The purpose of this article, therefore, is to provide a comprehensive review of current literature regarding postoperative pain management techniques in patients undergoing hip arthroscopy.

RECENT FINDINGS

Recent literature demonstrates the importance of a multimodal approach to treat postoperative pain in patients undergoing hip arthroscopy. When a peripheral nerve block or intraoperative anesthetic is used in combination with a pre- and postoperative analgesic medication regimen, patients report less pain and postoperative narcotic consumption. Patient-reported pain scores and postoperative opioid use were similar between the different modalities, however, postoperative complications appear to be less in groups receiving intra-articular (IA) injection or local anesthetic infiltration (LAI) compared to peripheral nerve blocks. In summary, we present evidence that intraoperative techniques, such as IA injection or LAI, in conjunction with pre- and postoperative pain medications, offers an effective multimodal strategy for treating postoperative pain following hip arthroscopy. This topic is of increasing importance due to the need for cost-effective strategies of managing pain and decreasing opioid consumption following hip arthroscopy.

摘要

综述目的

髋关节镜检查因其在众多髋关节疾病管理中的重要诊断和治疗价值,正成为一个快速发展的领域。在接受髋关节镜检查的患者中,充分控制术后疼痛仍是骨科领域一个具有挑战性且不断发展的领域。由于缺乏针对这些患者疼痛管理的标准化方案,人们采用了各种不同方法,试图找到一种能有效减轻术后疼痛、减少患者对麻醉药品的使用以及降低患者和医疗系统成本的方案。因此,本文旨在全面综述有关髋关节镜检查患者术后疼痛管理技术的当前文献。

最新发现

最新文献表明,采用多模式方法治疗接受髋关节镜检查患者的术后疼痛具有重要意义。当外周神经阻滞或术中麻醉与术前和术后镇痛药物方案联合使用时,患者报告的疼痛和术后麻醉药品使用量较少。不同模式下患者报告的疼痛评分和术后阿片类药物使用情况相似,然而,与外周神经阻滞相比,接受关节内(IA)注射或局部麻醉浸润(LAI)的组术后并发症似乎更少。总之,我们提供的证据表明,术中技术,如IA注射或LAI,与术前和术后疼痛药物联合使用,为治疗髋关节镜检查后的术后疼痛提供了一种有效的多模式策略。由于需要在髋关节镜检查后采用具有成本效益的疼痛管理策略并减少阿片类药物的使用,这个话题变得越来越重要。

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本文引用的文献

1
Minimal Clinically Important Difference and Substantial Clinical Benefit Values for a Pain Visual Analog Scale After Hip Arthroscopy.
Arthroscopy. 2019 Jul;35(7):2064-2069. doi: 10.1016/j.arthro.2019.02.032. Epub 2019 Jun 14.
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The Effect of Intra-articular Cocktail Versus Femoral Nerve Block for Patients Undergoing Hip Arthroscopy.
Arthroscopy. 2017 Dec;33(12):2170-2176. doi: 10.1016/j.arthro.2017.06.036. Epub 2017 Aug 31.
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