McClain Robert L, Porter Steven B, Arnold Scott M, Robards Christopher B
Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Jacksonville, Florida, USA.
Department of Physical Medicine & Rehabilitation, Mayo Clinic, Jacksonville, Florida, USA.
Rom J Anaesth Intensive Care. 2017 Oct;24(2):115-124. doi: 10.21454/rjaic.7518.242.prh.
Our aim was to ascertain the opinions and preferences of physical therapists with regard to use of peripheral nerve blocks and their impact on the recovery of patients undergoing total joint replacement.
We conducted an anonymous 24-question survey of 20 full-time inpatient physical therapists at a single tertiary care medical center.
One respondent indicated they never work with patients who have undergone total joint replacement surgery. Nineteen questionnaires were included in the final analysis. Questions omitted by respondents or with write-in answers were not included in the analysis. A majority of respondents (15 [78.9%]) agreed nerve blocks somewhat to greatly improve a patient's pain after total joint replacement surgery. Most respondents answered that nerve blocks somewhat to greatly impede a patient's ability to participate in physical therapy (14 [73.6%]) and make therapy somewhat to very difficult for them as physical therapists (16 [84.2%]). When asked about specific surgeries, (17/18 [94.4%]) and (14/18 [77.8%]) of respondents would prefer that their patients receive periarticular infiltration or no block at all after total knee arthroplasty or total hip arthroplasty, respectively. All respondents (19 [100%]) answered that they thought lower extremity nerve blocks increased a patient's risk of falling after surgery.
According to the physical therapists we surveyed, nerve blocks impede patient recovery and increase the risk of falls, despite their positive impact on pain control. When considering surgery for themselves, therapists indicated they would not want a nerve block.
我们的目的是确定物理治疗师对于外周神经阻滞的使用意见及偏好，以及其对全关节置换患者康复的影响。
我们在一家三级医疗中心对20名全职住院物理治疗师进行了一项包含24个问题的匿名调查。
一名受访者表示他们从未与接受过全关节置换手术的患者合作过。最终分析纳入了19份问卷。受访者遗漏或有手写答案的问题未纳入分析。大多数受访者（15人[78.9%]）同意神经阻滞在一定程度上至极大程度上改善了全关节置换手术后患者的疼痛。大多数受访者回答神经阻滞在一定程度上至极大程度上妨碍了患者参与物理治疗的能力（14人[73.6%]），并且对他们物理治疗师来说使治疗在一定程度上至非常困难（16人[84.2%]）。当被问及具体手术时，分别有（17/18[94.4%]）和（14/18[77.8%]）的受访者希望他们的患者在全膝关节置换术或全髋关节置换术后接受关节周围浸润或根本不进行阻滞。所有受访者（19人[100%]）回答他们认为下肢神经阻滞增加了患者术后跌倒的风险。
根据我们调查的物理治疗师的看法，神经阻滞尽管对疼痛控制有积极影响，但会妨碍患者康复并增加跌倒风险。当为自己考虑手术时，治疗师表示他们不希望进行神经阻滞。
