膝关节置换术后区域镇痛的功能恢复：随机对照试验的系统评价和荟萃分析。

Functional recovery after knee arthroplasty with regional analgesia: A systematic review and meta-analysis of randomised controlled trials.

机构信息

From the Service d'anesthésie, Hôpital Raymond Poincaré, Garches, Assistance Publique Hôpitaux de Paris (SB, DF, VM), INSERM, U-987, Hôpital Ambroise Paré, Centre d'Evaluation et de Traitement de la Douleur (TO, DF, VM), Université Versailles Saint-Quentin, Paris (DF, VM) and Département sciences infirmières et paramédicales Ecole des Hautes Etudes en santé publique, Rennes, France (J-PR).

出版信息

Eur J Anaesthesiol. 2019 Jun;36(6):418-426. doi: 10.1097/EJA.0000000000000983.

DOI:10.1097/EJA.0000000000000983

PMID:30950899

Abstract

BACKGROUND

Regional analgesia (RA) has been widely evaluated for pain relief after total knee arthroplasty (TKA). Its impact on functional recovery is less well known.

OBJECTIVES

To evaluate the functional benefits of RA after TKA.

DESIGN

Systematic review with a random-effects meta-analysis of randomised controlled trials comparing LRA with systemic analgesia on function in adults undergoing TKA for osteoarthritis.

DATABASE SOURCES

MEDLINE, EMBASE, LILAC, Cochrane, CTRD databases.

OUTCOMES

Length of stay (LOS) in hospital and early knee flexion range of motion (ROM), early and long-term knee function, serious adverse effects.

RESULTS

Twenty-three studies (1246 patients) were included. LOS was significantly shorter for RA than for systemic analgesia (0.90 days, 95% confidence interval 0.3 to 1.4). Subgroup analyses found that only infiltration analgesia decreased the LOS. ROM during the first week was significantly higher for all techniques of RA than for systemic analgesia (9.23°, 95% confidence interval 4.6 to 13.9). No impact of regional analgesia techniques on global function in the longer term was demonstrated. No difference in serious adverse effects was found between RA and systemic analgesia.

CONCLUSION

RA techniques compared with systemic analgesia have a beneficial impact on the LOS and the ROM achieved in the early postoperative period. Global function in the longer term after surgery seems unaffected by peri-operative RA.

TRIAL REGISTRATION

CRD42014013995.

摘要

背景

区域麻醉（RA）已广泛用于全膝关节置换术（TKA）后的止痛。其对功能恢复的影响知之甚少。

目的

评估 TKA 后 RA 的功能获益。

设计

对比较接受 TKA 治疗骨关节炎的成年人接受局部麻醉与全身镇痛在功能方面的随机对照试验进行系统评价和随机效应荟萃分析。

数据库来源

MEDLINE、EMBASE、LILAC、Cochrane、CTRD 数据库。

结局

住院时间（LOS）和膝关节早期屈曲活动度（ROM）、早期和长期膝关节功能、严重不良事件。

结果

共纳入 23 项研究（1246 例患者）。RA 组的 LOS 明显短于全身镇痛组（0.90 天，95%置信区间 0.3 至 1.4）。亚组分析发现只有浸润性镇痛可缩短 LOS。RA 的所有技术在术后第一周的 ROM 均明显高于全身镇痛（9.23°，95%置信区间 4.6 至 13.9）。没有证据表明 RA 技术对长期的总体功能有影响。RA 与全身镇痛在严重不良事件方面无差异。