局部浸润镇痛与外周神经阻滞麻醉在全膝关节置换术中的应用：药物经济学比较。
Local infiltration analgesia versus peripheral nerve block anaesthesia in total knee arthroplasty: a pharmaco-economic comparison.
机构信息
Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Charitéplatz 1, 10117, Berlin, Germany.
Berlin Institute of Health , Charitéplatz 1, 10117, Berlin, Germany.
出版信息
BMC Anesthesiol. 2022 Mar 25;22(1):80. doi: 10.1186/s12871-022-01620-w.
BACKGROUND
A superior analgesic method in perioperative pain-management of patients receiving total knee arthroplasty is the subject of controversial debate. Although higher cost-efficiency is claimed for the local infiltration analgesia (LIA), there is a lack of data on its costs compared to peripheral nerve block anaesthesia (PNBA). The goal of this study was to investigate the differences in immediate perioperative costs between the LIA and PNBA in treatment of patients receiving total knee arthroplasty.
METHODS
The comparison was conducted based on a randomized controlled clinical trial examining 40 patients with elective, primary total knee arthroplasty (TKA, 20 patients with LIA and 20 patients with PNBA). The analysis included surgical case costs, anaesthesiological case costs, material, costs of postoperative opioid requirements and catheter review visits for patients receiving PNBA.
RESULTS
The overall mean costs for the LIA-group were 4328.72€ and 4368.12€ for the PNBA (p = 0.851). While there was no statistically significant difference in surgical case costs, the anaesthesiological costs were lower with the LIA procedure (1370.26€ vs. 1542.45€, p = 0.048). Material costs in the LIA group were 4.18€/patient and 94.64€/patient with the PNBA. Costs for postoperative opioid requirements showed no statistically significant difference between the two procedures.
CONCLUSIONS
There is no relevant difference in immediate perioperative costs between LIA and PNBA. Shorter induction times lead to lower anaesthesiological case costs with the LIA. Overall economic aspects seem to play a less important role for determining an adequate procedure for perioperative pain management.
TRIAL REGISTRATION
The study was approved by the ethics-review-board of Charité Hospital Berlin (Ethikausschuss 4, Charité - Universitätsmedizin Berlin, on 16th February 2017) and registered with data safety authorities. Study patients provided written informed consent to participate in the trial. Study registry: ClinicalTrials.gov, NCT03114306 .
背景
在接受全膝关节置换术的患者围手术期疼痛管理中，一种更好的镇痛方法一直存在争议。尽管局部浸润镇痛（LIA）具有更高的成本效益，但与周围神经阻滞麻醉（PNBA）相比，其成本数据仍缺乏。本研究旨在探讨全膝关节置换术患者中 LIA 与 PNBA 即刻围手术期成本的差异。
方法
该研究基于一项随机对照临床试验，共纳入 40 例择期初次全膝关节置换术（TKA）患者（20 例接受 LIA，20 例接受 PNBA）。分析包括手术病例成本、麻醉病例成本、材料成本、接受 PNBA 的患者术后阿片类药物需求和导管复查的费用。
结果
LIA 组的总体平均费用为 4328.72 欧元，PNBA 组为 4368.12 欧元（p=0.851）。虽然手术病例成本无统计学差异，但 LIA 组的麻醉病例成本较低（1370.26 欧元 vs. 1542.45 欧元，p=0.048）。LIA 组的材料成本为每位患者 4.18 欧元，PNBA 组为每位患者 94.64 欧元。两种方法的术后阿片类药物需求成本无统计学差异。
结论
LIA 和 PNBA 之间即刻围手术期成本无显著差异。LIA 可缩短诱导时间，降低麻醉病例成本。整体经济因素似乎在确定围手术期疼痛管理的适当方法方面作用较小。
试验注册
本研究经柏林 Charité 医院伦理审查委员会（2017 年 2 月 16 日，Charité - Universitätsmedizin Berlin，伦理委员会 4）批准，并在数据安全机构注册。研究患者书面同意参加试验。研究注册号：ClinicalTrials.gov，NCT03114306。
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