Aldanyowi Saud N
Orthopedic Surgery, College of Medicine, King Faisal University, Al-Ahsa 31982, Saudi Arabia.
Life (Basel). 2023 Dec 15;13(12):2351. doi: 10.3390/life13122351.
Effective postoperative pain management is critical for recovery after orthopedic surgery, but often remains inadequate despite multimodal analgesia. This systematic review synthesizes evidence on innovative modalities for enhancing pain control following major orthopedic procedures. Fifteen randomized controlled trials and comparative studies evaluating peripheral nerve blocks, local anesthetic infiltration, cryotherapy, transcutaneous electrical stimulation, adjunct medications, and other techniques are included. Thematic analysis reveals that peripheral nerve blocks and local anesthetic infiltration consistently demonstrate reduced pain scores, opioid consumption, and side effects versus conventional analgesia alone. Oral multimodal medications also show promise as part of opioid-sparing regimens. Adjunctive approaches like cryotherapy, music, and dexmedetomidine require further research to optimize protocols. Despite promising innovations, critical knowledge gaps persist regarding comparative effectiveness, optimal interventions and dosing, combination strategies, cost-effectiveness, and implementation. High-quality randomized controlled trials using standardized protocols are essential to guide the translation of enhanced multimodal regimens into clinical practice. This review provides a framework for pursuing research priorities and advancing evidence-based postoperative pain management across orthopedic surgeries.
有效的术后疼痛管理对于骨科手术后的恢复至关重要，但尽管采用了多模式镇痛，疼痛管理往往仍不充分。本系统评价综合了关于在主要骨科手术中增强疼痛控制的创新方法的证据。纳入了15项评估外周神经阻滞、局部麻醉药浸润、冷冻疗法、经皮电刺激、辅助药物及其他技术的随机对照试验和比较研究。主题分析表明，与单纯传统镇痛相比，外周神经阻滞和局部麻醉药浸润始终显示出疼痛评分降低、阿片类药物消耗量减少及副作用减轻。口服多模式药物作为阿片类药物节省方案的一部分也显示出前景。冷冻疗法、音乐和右美托咪定等辅助方法需要进一步研究以优化方案。尽管有前景的创新不断涌现，但在比较有效性、最佳干预措施和剂量、联合策略、成本效益及实施方面，关键的知识空白依然存在。采用标准化方案的高质量随机对照试验对于指导将强化多模式方案转化为临床实践至关重要。本综述为确定研究重点及推进骨科手术中基于证据的术后疼痛管理提供了一个框架。
