Krishna Prasad G V
Anaesthesiologist, Military Hospital Kirkee, Pune, Maharashtra, India.
Saudi J Anaesth. 2020 Jan-Mar;14(1):85-90. doi: 10.4103/sja.SJA_494_19. Epub 2020 Jan 6.
Post-operative knee pain management has become a challenge to provide early relief and pain-free postoperative care to the patient. The major objectives of post-operative analgesic treatment are to reduce opioid requirements, post-operative pain, and adverse events related to opioid intake. This narrative review aimed to document post-operative analgesia techniques after total knee arthroplasty (TKA). The traditional approach involved high-dose opioid-based regimen, though opioid is considered strong analgesic, but are associated with a number of unwanted side effects to seek for alternative techniques. The role of sciatic nerve block in TKA pain is doubtful. Femoral Nerve Block (FNB) is still considered as the gold standard; however, FNB is associated with quadriceps weakness and risk of fall and sciatic block with foot drop. To overcome these drawback more distal nerve block techniques has evolved, namely saphenous nerve block in adductor canal, selective tibial which are claimed to provide comparable analgesia to that of femoral and sciatic nerve block. The combination of pre-emptive and multi-modal analgesia and technically well-delivered regional nerve blocks and postoperative physical therapy are an essential component which not only minimize the side effects of traditional opioid-based analgesia but also speed up functional recovery, increases patient satisfaction, and reduces the overall length of hospitalization and cost.
膝关节术后疼痛管理已成为一项挑战，即如何为患者提供早期疼痛缓解及无痛的术后护理。术后镇痛治疗的主要目标是减少阿片类药物的用量、术后疼痛以及与阿片类药物摄入相关的不良事件。本叙述性综述旨在记录全膝关节置换术（TKA）后的术后镇痛技术。传统方法采用高剂量阿片类药物方案，尽管阿片类药物被认为是强效镇痛药，但会带来许多不良副作用，因此需要寻找替代技术。坐骨神经阻滞在TKA疼痛中的作用尚不确定。股神经阻滞（FNB）仍被视为金标准；然而，FNB与股四头肌无力、跌倒风险相关，而坐骨神经阻滞与足下垂有关。为克服这些缺点，更远端的神经阻滞技术应运而生，即内收肌管内隐神经阻滞、选择性胫神经阻滞，据称这些技术能提供与股神经和坐骨神经阻滞相当的镇痛效果。超前镇痛与多模式镇痛相结合、技术操作良好的区域神经阻滞以及术后物理治疗是重要组成部分，这不仅能将传统阿片类药物镇痛的副作用降至最低，还能加速功能恢复、提高患者满意度，并缩短总体住院时间和降低费用。
