全膝关节置换术中局部浸润镇痛与股神经阻滞的Meta分析
Local infiltration analgesia versus femoral nerve block in total knee arthroplasty: a meta-analysis.
作者信息
Yun X-D, Yin X-L, Jiang J, Teng Y-J, Dong H-T, An L-P, Xia Y-Y
机构信息
Department of Orthopaedics, Orthopaedics Key Laboratory of Gansu Province, Second Hospital of Lanzhou University, No. 82 Cuiyingmen, Chengguan District, Lanzhou, Gansu, PR China.
Department of Orthopaedics, Orthopaedics Key Laboratory of Gansu Province, Second Hospital of Lanzhou University, No. 82 Cuiyingmen, Chengguan District, Lanzhou, Gansu, PR China.
出版信息
Orthop Traumatol Surg Res. 2015 Sep;101(5):565-9. doi: 10.1016/j.otsr.2015.03.015. Epub 2015 May 16.
INTRODUCTION
Local infiltration analgesia (LIA) and femoral nerve block (FNB) are both used for the pain management after total knee arthroplasty (TKA). Controversy still remains regarding the optimal technique for pain relief in patients undergoing TKA. The purpose of this meta-analysis was to compare the analgesia achieved with LIA and the one from FNB following TKA.
HYPOTHESIS
LIA achieves better pain control than FNB in patients with TKA.
METHODS
Databases, including Pubmed, EMBASE, the Cochrane Library and Web of Science were comprehensively searched to identify studies comparing LIA with FNB for patients with TKA. Two reviewers independently selected trials, extracted data, and assessed the methodological qualities of included studies. Data were analyzed by RevMan 5.2.
RESULTS
Nine RCTs involving 782 patients were included. LIA achieved more rapid pain relief (VAS) at 6h postoperatively [SMD6h=-0.92, 95% CI (-1.38, -0.47)] than FNB. There were no significant differences at 24h and 48h [SMD24h=-0.03, 95% CI (-0.46, 0.40); SMD48h=0.28, 95% CI (-0.35, 0.91)], VAS with activity at 24h and 48h [SMD6h=-0.54, 95% CI (-1.62, 0.54); SMD24h=-0.22, 95% CI (-1.41, 0.96); SMD48h=-0.08, 95% CI (-0.52, 0.69)], opioid consumption at 24h and 48h [SMD24h=-0.24, 95% CI (-0.82, 0.34); SMD48h=0.15, 95% CI (0.25, 0.54)] and length of hospital stay [MD=-0.52, 95% CI (-1.13, 0.09)].
DISCUSSION
LIA may be the better choice in the pain management of TKA for it could achieve fast pain relief and is easier to perform than FNB for patients with TKA.
LEVEL OF EVIDENCE
Level II, meta-analysis and systematic review.
引言
局部浸润镇痛（LIA）和股神经阻滞（FNB）均用于全膝关节置换术（TKA）后的疼痛管理。对于接受TKA的患者，哪种最佳镇痛技术仍存在争议。本荟萃分析的目的是比较TKA后LIA和FNB的镇痛效果。
假设
在TKA患者中，LIA比FNB能更好地控制疼痛。
方法
全面检索包括Pubmed、EMBASE、Cochrane图书馆和科学网在内的数据库，以识别比较TKA患者LIA和FNB的研究。两名评价者独立选择试验、提取数据并评估纳入研究的方法学质量。数据采用RevMan 5.2进行分析。
结果
纳入9项随机对照试验，共782例患者。LIA在术后6小时疼痛缓解更快（视觉模拟评分法[VAS]）[标准化均数差（SMD）6小时=-0.92，95%可信区间（CI）（-1.38，-0.47）]，优于FNB。在24小时和48小时时无显著差异[SMD24小时=-0.03，95%CI（-0.46，0.40）；SMD48小时=0.28，95%CI（-0.35，0.91）]，24小时和48小时活动时的VAS[SMD6小时=-0.54，95%CI（-1.62，0.54）；SMD24小时=-0.22，95%CI（-1.41，0.96）；SMD48小时=-0.08，95%CI（-0.52，0.69）]，24小时和48小时的阿片类药物消耗量[SMD24小时=-0.24，95%CI（-0.82，0.34）；SMD48小时=0.15，95%CI（-0.25，0.54）]以及住院时间[均差（MD）=-0.52，95%CI（-1.13，0.09）]。
讨论
LIA可能是TKA疼痛管理的更好选择，因为它能实现快速疼痛缓解，且对于TKA患者比FNB更容易实施。
证据水平
二级，荟萃分析和系统评价。
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