Pagnotto Michael R, Pagnano Mark W
Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, USA.
Instr Course Lect. 2012;61:389-95.
Multimodal pain management techniques using femoral and sciatic nerve blocks can dramatically improve a patient's experience after total knee arthroplasty. Nerve blocks reduce postoperative pain and the need for parenteral opioids and result in fewer medical complications associated with opioid use. Peripheral nerve blocks have traditionally been underutilized in lower extremity surgery; however, more modern techniques now allow for safe, efficient, and reliable femoral and sciatic blocks. Peripheral nerve blocks are now routinely used in both primary and revision total knee arthroplasty. Although it is difficult to isolate the added benefit of sciatic nerve blocks, there is a growing body of evidence for using femoral and/or sciatic nerve blocks as part of a multimodal approach to pain management. With many years of experience and published results on thousands of patients, it is clear that the risks of peripheral nerve blocks are minimal, whereas the benefits are substantial.
使用股神经和坐骨神经阻滞的多模式疼痛管理技术可显著改善全膝关节置换术后患者的体验。神经阻滞可减轻术后疼痛并减少胃肠外阿片类药物的使用，还可减少与阿片类药物使用相关的医疗并发症。传统上，外周神经阻滞在下肢手术中的应用不足；然而，现在更现代的技术使安全、高效且可靠的股神经和坐骨神经阻滞成为可能。外周神经阻滞现在常规用于初次和翻修全膝关节置换术。虽然很难分离出坐骨神经阻滞的额外益处，但越来越多的证据支持将股神经和/或坐骨神经阻滞作为多模式疼痛管理方法的一部分。凭借多年经验以及数千例患者的发表结果，很明显外周神经阻滞的风险极小，而益处显著。
