Simanski C J P
Klinik für Unfallchirurgie, Orthopädie und Sporttraumatologie Köln-Merheim, Lehrstuhl für Unfallchirurgie und Orthopädie der Universität Witten-Herdecke, Ostmerheimer Strasse 200, 51109, Köln, Deutschland.
Orthopade. 2008 Oct;37(10):959-60, 962-9. doi: 10.1007/s00132-008-1337-y.
Pain therapy after surgical procedures of the lower extremity is an important goal, whereas insufficient analgesia leads to an essential reduction of the patient's mobility and convalescence. If possible, regional anaesthetic and intrathecal procedures for pre-, intra- and postoperative analgesia should be used. Systemic analgesics should not be used preoperatively, whereas non-opioids and opioids are recommended postoperatively. Surgical options that adequately reduce pain are intra-articular injection of local anaesthetics alone or in combination with opioids and cooling and physiotherapeutic treatment regimens after joint procedures. There is no scientific rationale as an argument for inserting drains. The surgical approach depends more on the individual patient's anatomical characteristics. Whereas the regional analgesic regimen is more effective than systemic therapy, sufficient tools for pain reduction during surgical procedures of the lower extremity are at the orthopaedic surgeon's disposal, too.
下肢手术后的疼痛治疗是一个重要目标，而镇痛不足会导致患者活动能力和康复进程显著降低。如有可能，应采用区域麻醉和鞘内给药方法进行术前、术中和术后镇痛。术前不应使用全身性镇痛药，而术后推荐使用非阿片类药物和阿片类药物。充分减轻疼痛的手术选择包括关节内单独注射局部麻醉药或与阿片类药物联合使用，以及关节手术后的冷敷和物理治疗方案。没有科学依据支持放置引流管。手术方式更多地取决于个体患者的解剖特征。虽然区域镇痛方案比全身治疗更有效，但在下肢手术过程中，骨科医生也有足够的减轻疼痛的手段。
