Zhang Yeying, Lu Ming, Chang Cheng
Department of Anesthesiology, the Affiliated Hospital of Hangzhou Normal University, 126 Wenzhou Road, Hangzhou, Zhejiang, 310015, China.
Department of Cardiology, Second Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, Zhejiang, 310005, China.
BMC Musculoskelet Disord. 2017 Jan 23;18(1):32. doi: 10.1186/s12891-016-1382-3.
We performed a systematic review and meta-analysis of randomized controlled trials (RCTs) were to evaluate the effect and safety of local anesthetic infusion pump versus placebo for pain management following total knee arthroplasty (TKA).
In September 2016, a systematic computer-based search was conducted in the Pubmed, ISI Web of Knowledge, Embase, Cochrane Database of Systematic Reviews. Randomized controlled trials of patients prepared for primary TKA that compared local anesthetic infusion pump versus placebo for pain management following TKA were retrieved. The primary endpoint was the visual analogue scale (VAS) with rest or mobilization at 24, 48 and 72 h and morphine consumption at 24 and 48 h. The second outcomes are range of motion, length of hospital stay (LOS) and complications (infection, deep venous thrombosis (DVT), prolonged drainage and postoperative nausea and vomiting (PONV)).
Seven clinical studies with 587 patients were included and for meta-analysis. Local anesthetic infusion pump are associated with less pain scores with rest or mobilization at 24 and 48 h with significant difference. However, the difference was likely no clinical significance. There were no significant difference between the LOS, the occurrence of DVT, prolonged drainage and PONV. However, local anesthetic infusion pump may be associated with more infection.
Based on the current meta-analysis, we found no evidence to support the routine use of local anesthetic infusion pump in the management of acute pain following TKA. More RCTs are still need to identify the pain control effects and optimal dose and speed of local anesthetic pain pump.
我们进行了一项随机对照试验（RCT）的系统评价和荟萃分析，以评估局部麻醉药输注泵与安慰剂在全膝关节置换术（TKA）后疼痛管理中的效果和安全性。
2016年9月，在PubMed、ISI Web of Knowledge、Embase、Cochrane系统评价数据库中进行了基于计算机的系统检索。检索了比较局部麻醉药输注泵与安慰剂在TKA后疼痛管理中的原发性TKA患者的随机对照试验。主要终点是24、48和72小时静息或活动时的视觉模拟量表（VAS）以及24和48小时的吗啡消耗量。次要结局是关节活动范围、住院时间（LOS）和并发症（感染、深静脉血栓形成（DVT）、引流延长和术后恶心呕吐（PONV））。
纳入7项临床研究，共587例患者进行荟萃分析。局部麻醉药输注泵与24和48小时静息或活动时疼痛评分较低相关，差异有统计学意义。然而，这种差异可能无临床意义。LOS、DVT发生率、引流延长和PONV之间无显著差异。然而，局部麻醉药输注泵可能与更多感染相关。
基于目前的荟萃分析，我们没有发现证据支持在TKA后急性疼痛管理中常规使用局部麻醉药输注泵。仍需要更多的随机对照试验来确定局部麻醉药镇痛泵的疼痛控制效果以及最佳剂量和速度。
