前交叉韧带重建术后的疼痛管理策略：系统评价与网络荟萃分析。
Pain Management Strategies After Anterior Cruciate Ligament Reconstruction: A Systematic Review With Network Meta-analysis.
机构信息
Sports Medicine Division, Orthopaedic Surgery Department, NYU Langone Health, New York, New York, U.S.A.; Royal College of Surgeons in Ireland, Dublin, Ireland.
Sports Medicine Division, Orthopaedic Surgery Department, NYU Langone Health, New York, New York, U.S.A.; Royal College of Surgeons in Ireland, Dublin, Ireland.
出版信息
Arthroscopy. 2021 Apr;37(4):1290-1300.e6. doi: 10.1016/j.arthro.2021.01.023. Epub 2021 Jan 28.
PURPOSE
To systematically review randomized controlled trials (RCTs) evaluating various pain control interventions after anterior cruciate ligament reconstruction (ACLR) to determine the best-available evidence in managing postoperative pain and to optimize patient outcomes.
METHODS
A systematic review of the literature was performed based on the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-analyses) guidelines. A study was included if it was an RCT evaluating an intervention to reduce postoperative pain acutely after ACLR in one of the following areas: (1) nerve blocks, (2) nerve block adjuncts, (3) intra-articular injections, (4) oral medications, (5) intravenous medications, (6) tranexamic acid, and (7) compressive stockings and cryotherapy. Quantitative and qualitative statistics were carried out, and network meta-analysis was performed where applicable.
RESULTS
Overall, 74 RCTs were included. Across 34 studies, nerve blocks were found to significantly reduce postoperative pain and opioid use, but there was no significant difference among the various nerve blocks in the network meta-analysis. Intra-articular injections consisting of bupivacaine and an adjunct were found to reduce reported postoperative pain scores up to 12 hours after ACLR, with significantly lower postoperative opioid use.
CONCLUSIONS
Nerve blocks and regional anesthesia are the mainstay treatment of postoperative pain after ACLR, with the commonly used nerve blocks being equally efficacious. Intra-articular injections consisting of bupivacaine and an adjunct were found to reduce reported postoperative pain scores up to 12 hours after ACLR, with significantly lower postoperative opioid use. There was promising evidence for the use of some oral and intravenous medications, tranexamic acid, and nerve block adjuncts, as well as cryotherapy, to control pain and reduce postoperative opioid use.
LEVEL OF EVIDENCE
Level II, systematic review and meta-analysis of RCTs.
目的
系统回顾评估前交叉韧带重建（ACLR）后各种疼痛控制干预措施的随机对照试验（RCT），以确定管理术后疼痛的最佳现有证据，并优化患者结局。
方法
根据 PRISMA（系统评价和荟萃分析的首选报告项目）指南进行文献系统回顾。如果研究是 RCT，评估 ACLR 后以下一个或多个领域的干预措施以减轻急性术后疼痛，则将其纳入研究：（1）神经阻滞，（2）神经阻滞辅助剂，（3）关节内注射，（4）口服药物，（5）静脉内药物，（6）氨甲环酸和（7）压缩袜和冷敷。进行了定量和定性统计分析，并在适用的情况下进行了网络荟萃分析。
结果
总共纳入了 74 项 RCT。在 34 项研究中，发现神经阻滞可显著减轻术后疼痛和阿片类药物的使用，但在网络荟萃分析中，各种神经阻滞之间没有显著差异。关节内注射布比卡因和辅助剂可降低 ACLR 后 12 小时内报告的术后疼痛评分，且术后阿片类药物的使用显著降低。
结论
神经阻滞和区域麻醉是 ACLR 后治疗术后疼痛的主要方法，常用的神经阻滞同样有效。关节内注射布比卡因和辅助剂可降低 ACLR 后 12 小时内报告的术后疼痛评分，且术后阿片类药物的使用显著降低。一些口服和静脉内药物、氨甲环酸和神经阻滞辅助剂以及冷敷在控制疼痛和减少术后阿片类药物使用方面有一定的证据支持。
证据水平
II 级，RCT 的系统评价和荟萃分析。
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