Clinique Santé Cannabis, Montreal, Quebec, Canada.
International Director of Medical Services, Khiron Life Sciences Corp., Bogota.
Curr Opin Anaesthesiol. 2019 Oct;32(5):661-667. doi: 10.1097/ACO.0000000000000772.
This article discussed how the knowledge and technique of a few chronic pain procedures benefited the perioperative clinicians in their care of patients receiving specific orthopaedic surgical procedures.
Recent emerging interest in hip and knee denervation for chronic pain management secondary to osteoarthritis stimulates publications on the new understanding of hip and knee joint innervation. The improved understanding of the anatomy allows better precision in targeting the articular branches. The procedures for chronic joint pain such as radiofrequency ablation, chemical neurolysis and neuromodulation procedure have recently been applied to the perioperative care in orthopaedic procedures because of the potential long-lasting analgesia, opioid-sparing effect and consequent improvement in physical function and health-related quality of life after surgery.
Despite the widespread use of regional anaesthesia and multimodal analgesia in the perioperative pain management, more than two-third of the patients reported severe postoperative pain. Therefore, other therapeutic strategies used in chronic pain management such as radiofrequency ablation and neuromodulation have been proposed to optimize acute postsurgical pain. The early experience with those techniques is encouraging, and more studies are required to explore the incorporation of these procedures in the perioperative care.
本文讨论了一些慢性疼痛处理技术和知识如何使围手术期临床医生在对接受特定矫形外科手术的患者进行治疗时受益。
由于骨关节炎导致的慢性疼痛管理中对髋关节和膝关节去神经支配的新兴趣激发了有关髋关节和膝关节神经支配的新认识的出版物。对解剖结构的更好理解使得关节分支的靶向更加精确。射频消融、化学神经溶解和神经调节等慢性关节疼痛处理程序最近已应用于矫形手术的围手术期护理，因为这些程序具有潜在的持久镇痛、减少阿片类药物使用的效果，并且可以改善术后的身体功能和健康相关生活质量。
尽管在围手术期疼痛管理中广泛使用区域麻醉和多模式镇痛，但仍有超过三分之二的患者报告有严重的术后疼痛。因此，已经提出了诸如射频消融和神经调节等用于慢性疼痛管理的其他治疗策略，以优化急性术后疼痛。这些技术的早期经验令人鼓舞，需要更多的研究来探索将这些程序纳入围手术期护理。
