Fischer H B J, Simanski C J P, Sharp C, Bonnet F, Camu F, Neugebauer E A M, Rawal N, Joshi G P, Schug S A, Kehlet H
Department of Anaesthesia, Alexandra Hospital, Redditch, UK.
Anaesthesia. 2008 Oct;63(10):1105-23. doi: 10.1111/j.1365-2044.2008.05565.x. Epub 2008 Jul 10.
The PROSPECT Working Group, a collaboration of anaesthetists and surgeons, conducts systematic reviews of postoperative pain management for different surgical procedures (http://www.postoppain.org). Evidence-based consensus recommendations for the effective management of postoperative pain are then developed from these systematic reviews, incorporating clinical practice observations, and transferable evidence from other relevant procedures. We present the results of a systematic review of pain and other outcomes following analgesic, anaesthetic and surgical interventions for total knee arthroplasty (TKA). The evidence from this review supports the use of general anaesthesia combined with a femoral nerve block for surgery and postoperative analgesia, or alternatively spinal anaesthesia with local anaesthetic plus spinal morphine. The primary technique, together with cooling and compression techniques, should be supplemented with paracetamol and conventional non-steroidal anti-inflammatory drugs or COX-2-selective inhibitors, plus intravenous strong opioids (high-intensity pain) or weak opioids (moderate- to low-intensity pain).
由麻醉师和外科医生组成的PROSPECT工作组，对不同外科手术的术后疼痛管理进行系统评价（http://www.postoppain.org）。然后，基于这些系统评价，结合临床实践观察结果以及其他相关手术中可借鉴的证据，制定出关于术后疼痛有效管理的循证共识建议。我们展示了一项针对全膝关节置换术（TKA）镇痛、麻醉和手术干预后疼痛及其他结局的系统评价结果。该评价的证据支持在手术和术后镇痛中使用全身麻醉联合股神经阻滞，或者使用局部麻醉加脊髓吗啡的脊髓麻醉。主要技术，连同冷却和压迫技术，应辅以对乙酰氨基酚和传统非甾体抗炎药或COX-2选择性抑制剂，再加上静脉注射强效阿片类药物（高强度疼痛）或弱效阿片类药物（中低强度疼痛）。
