De Luca Maria Laura, Ciccarello Marcello, Martorana Manfredi, Infantino Davide, Letizia Mauro Giulia, Bonarelli Stefano, Benedetti Maria Grazia
Physical Medicine and Rehabilitation Unit.
Anesthesia-resuscitation and Intensive care Unit, Rizzoli Sicilia Department, Bagheria.
Medicine (Baltimore). 2018 Oct;97(40):e12484. doi: 10.1097/MD.0000000000012484.
Total hip replacement (THR) and, particularly, total knee replacement (TKR), are painful surgical procedures. Effective postoperative pain management leads to a better and earlier functional recovery and prevents chronic pain. Studies on the control of pain during the postoperative rehabilitation period are not common. The aim of this study is to present results of a perioperative anesthetic protocol, and a pain treatment protocol in use in the Orthopaedic and the Rehabilitation intensive units of our Hospital. 100 patients (50 THR and 50 TKR) were retrospectively included in this observational study. Numeric Rating Scale (NRS) for pain at rest registered in the clinical sheet was retrieved for all patients and analyzed with respect to the spinal anaesthesia given for the surgery, local analgesia, analgesia protocol adopted during the postoperative days in the Orthopaedic Unit, the antalgic treatment given during the stay within the Rehabilitation Unit, the postoperative consumption of rescue pain medication, and any collateral effect due to the analgesic therapy. Patients reached standard functional abilities (walking at least 50 meters and climbing/descending stairs) at a mean length of 8 days without medication-related complications. Mean NRS during the time of stay was 1.3 ± 0.3 for THR and 1.3 ± 0.2 for TKR) and maximum mean NRS was 1.8 ± 0.5 for TKR and 1.8 ± 0.6 for THR. The use of rescue therapy in the rehabilitation guard was correlated with the mean NRS pain and the maximum NRS pain. A very good control of pain with the perioperative anesthetic protocol and pain treatment protocol in use was obtained.
全髋关节置换术（THR），尤其是全膝关节置换术（TKR），是痛苦的外科手术。有效的术后疼痛管理可带来更好、更早的功能恢复，并预防慢性疼痛。关于术后康复期疼痛控制的研究并不常见。本研究的目的是介绍我院骨科和康复重症监护病房正在使用的围手术期麻醉方案和疼痛治疗方案的结果。本观察性研究回顾性纳入了100例患者（50例行THR，50例行TKR）。检索了所有患者临床记录中登记的静息时疼痛数字评分量表（NRS），并就手术时给予的脊髓麻醉、局部镇痛、骨科病房术后几天采用的镇痛方案、康复病房住院期间给予的止痛治疗、术后急救止痛药物的使用情况以及镇痛治疗的任何副作用进行了分析。患者平均在8天内达到标准功能能力（至少行走50米以及上下楼梯），且无药物相关并发症。住院期间THR的平均NRS为1.3±0.3，TKR为1.3±0.2；TKR的最大平均NRS为1.8±0.5，THR为1.8±0.6。康复监护中急救治疗的使用与平均NRS疼痛和最大NRS疼痛相关。使用现有的围手术期麻醉方案和疼痛治疗方案可实现对疼痛的良好控制。
