Barrington John W, Halaszynski Thomas M, Sinatra Raymond S, Expert Working Group On Anesthesia And Orthopaedics Critical Issues In Hip And Knee Replacement Arthroplasty For The
Am J Orthop (Belle Mead NJ). 2014 Apr;43(4 Suppl):S1-S16.
Many patients who undergo hip or knee replacement surgery today experience high levels of postoperative pain. Data from clinical studies and analyses of hospital records have demonstrated that severe postoperative pain is associated with an increased risk for complications, slowing of the rehabilitation process, delayed return to normal functioning, progression to persistent pain states, prolonged length of hospital stay, elevated rates of readmission, and higher overall costs. Orthopedic surgeons may now play a more active role in reducing the severity of pain following surgery, decreasing both opioid use and the incidence of opioid-related adverse events, and eliminating breakthrough pain and analgesic gaps. The benefits of multimodal regimens that include a combination of agents acting synergistically have been established unequivocally, and many analgesic and anesthetic agents are now available, as well as treatment options that differ according to route of administration. It is therefore possible to individualize treatment based on the type of procedure and patient need. One exciting advance that offers effective, safe, and efficient analgesia for many kinds of surgical procedures is the introduction of an extended-release local anesthetic (liposomal bupivacaine) for infiltration. This new option, which can be administered directly into the knee or hip by an orthopedic surgeon, is an example of the changing paradigm in perioperative analgesia, where commitment, communication, and coordination across all members of the clinical care team- including the surgeon, anesthesiologist, pharmacist, physical therapist, and nursing staff-are fundamental elements of an improved standard of care. An Expert Working Group on Anesthesia and Orthopaedics: Critical Issues in Hip and Knee Replacement Arthroplasty (April 13, 2013; Dallas, Texas) evaluated current approaches to perioperative pain management and proposed new regimens to help achieve optimal outcomes in these procedures.
如今，许多接受髋关节或膝关节置换手术的患者术后疼痛程度较高。临床研究数据以及医院记录分析表明，术后剧痛会增加并发症风险、减缓康复进程、延迟恢复正常功能、发展为持续性疼痛状态、延长住院时间、提高再入院率并增加总体费用。骨科医生现在可能需要在减轻术后疼痛严重程度、减少阿片类药物使用及阿片类药物相关不良事件发生率、消除爆发性疼痛和镇痛空白方面发挥更积极的作用。包含协同作用药物组合的多模式方案的益处已得到明确证实，现在有许多镇痛和麻醉药物可供使用，还有根据给药途径不同的治疗选择。因此，可以根据手术类型和患者需求进行个体化治疗。一项令人兴奋的进展是引入了用于浸润的长效局部麻醉剂（脂质体布比卡因），它能为多种外科手术提供有效、安全且高效的镇痛。这种新选择可由骨科医生直接注入膝关节或髋关节，它是围手术期镇痛不断变化的模式的一个例子，在这种模式中，临床护理团队的所有成员——包括外科医生、麻醉师、药剂师、物理治疗师和护理人员——之间的承诺、沟通和协调是提高护理标准的基本要素。一个麻醉与骨科专家工作组：髋关节和膝关节置换术的关键问题（2013年4月13日；得克萨斯州达拉斯）评估了围手术期疼痛管理的当前方法，并提出了新的方案，以帮助在这些手术中实现最佳效果。
