Elmallah Randa K, Cherian Jeffrey J, Pierce Todd P, Jauregui Julio J, Harwin Steven F, Mont Michael A
Rubin Institute for Advanced Orthopedics, Center for Joint Preservation and Replacement, Sinai Hospital of Baltimore, Baltimore, Maryland.
Department of Orthopaedic Surgery, Mount Sinai Beth Israel Medical Center, New York, New York.
J Knee Surg. 2016 Feb;29(2):169-78. doi: 10.1055/s-0035-1549027. Epub 2015 Apr 18.
Optimal pain control in patients undergoing total knee arthroplasty (TKA) is imperative for good rehabilitation and functional outcomes. However, despite technological advancements, surgeons continue to struggle with adequate pain management in their patients. Current modalities in use, such as patient-controlled analgesia, opioids, and epidural anesthetics, provide good pain relief but can be associated with side effects and serious complications. As a result, newer pain control modalities have been used to try to reduce the use of opioids while providing adequate pain relief. Currently, there are no clear guidelines or evidence for an optimum postoperative TKA analgesic regimen. Our aim was to evaluate the recent literature and provide a summary of the newer perioperative analgesic modalities. Evidence suggests that analgesics, such as newer oral medications, peripheral nerve blocks, and periarticular injections, may improve pain management, rehabilitation, and patient satisfaction, as well as reduce opioid consumption. The literature has also highlighted that a multimodal approach to pain management may provide the best results. However, determining which modalities provide superior pain control is still being extensively studied, and further research is needed.
对于接受全膝关节置换术（TKA）的患者而言，实现最佳疼痛控制对于良好的康复和功能预后至关重要。然而，尽管技术不断进步，外科医生在为患者进行充分的疼痛管理方面仍面临困难。目前使用的方法，如患者自控镇痛、阿片类药物和硬膜外麻醉，虽能有效缓解疼痛，但可能会伴有副作用和严重并发症。因此，人们尝试采用更新的疼痛控制方法，在提供充分疼痛缓解的同时减少阿片类药物的使用。目前，尚无明确的指南或证据表明存在最佳的TKA术后镇痛方案。我们的目的是评估近期文献，并总结更新的围手术期镇痛方法。有证据表明，诸如新型口服药物、外周神经阻滞和关节周围注射等镇痛药，可能会改善疼痛管理、康复情况及患者满意度，同时减少阿片类药物的用量。文献还强调，多模式疼痛管理方法可能会带来最佳效果。然而，确定哪些方法能提供更优的疼痛控制仍在广泛研究中，还需要进一步的研究。
