持续腰丛神经阻滞在髋部或股骨骨科手术后疼痛管理中的疗效:一项系统评价和荟萃分析

Efficacy of Continuous Lumbar Plexus Blockade in Managing Post-Operative Pain after Hip or Femur Orthopedic Surgeries: A Systematic Review and Meta-Analysis.

作者信息

AlMutiri Wijdan A, AlMajed Ebtesam, Alneghaimshi Muath M, AlAwadh Afnan, AlSarhan Reem, AlShebel Malak N, AlMatrody Rayan Abdullah M, Hadaddi Rafa, AlTamimi Reem, Bin Salamah Rawan, AlZelfawi Lama A, AlBatati Saud K, AlHarthi Alanood, AlMazroa Ghayda, AlHossan Abdullah M

机构信息

College of Medicine, Princess Nourah bint Abdulrahaman University, Riyadh 11671, Saudi Arabia.

Orthopaedic Surgery Department, King Fahad Military Medical Complex, Dhahran 31932, Saudi Arabia.

出版信息

J Clin Med. 2024 May 29;13(11):3194. doi: 10.3390/jcm13113194.

Abstract

Post-operative pain management is essential for optimizing recovery, patient comfort, and satisfaction. Peripheral nerve blockade, or lumbar plexus block (LPB), has been widely used for analgesia and regional anesthesia. This study explored the existing literature to determine the efficacy of continuous lumbar plexus blockade in managing post-operative pain following hip or femur surgery. Reviewers comprehensively searched electronic databases to identify peer-reviewed scholarly articles reporting the efficacy of lumbar plexus block in managing post-operative pain after orthopedic surgery. The potential articles were carefully selected and assessed for the risk of bias using the Cochrane Collaboration Risk of Bias assessment tool. Data were systematically extracted and analyzed. The literature search yielded 206 articles, 20 of which were randomized controlled trials. Lumbar plexus block demonstrated superior pain relief compared to conventional pain management approaches like general anesthetics. In addition, LPB reduced patients' overall opioid consumption compared to controls, reduced adverse effects, and enhanced functional recovery, which underlines the broader positive impact of meticulous pain management. More patients could walk more than 40 feet after the second day post-operatively among the lumbar plexus group (14.7%) compared to the continuous femoral group (1.3%). Other parameters, including cortisol levels and hemodynamic stability, were evaluated, showing comparable outcomes. Lumbar plexus block is effective in pain management after orthopedic surgery, as shown by the lower pain scores and less opioid consumption. Additionally, patient satisfaction was relatively higher in LPB-treated patients compared to other approaches like general anesthesia.

摘要

术后疼痛管理对于优化恢复、提高患者舒适度和满意度至关重要。外周神经阻滞,即腰丛阻滞(LPB),已广泛用于镇痛和区域麻醉。本研究通过查阅现有文献,以确定连续腰丛阻滞在髋部或股骨手术后疼痛管理中的疗效。研究人员全面检索了电子数据库,以识别经同行评审的学术文章,这些文章报告了腰丛阻滞在骨科手术后疼痛管理中的疗效。使用Cochrane协作偏倚风险评估工具,对潜在文章进行了仔细筛选和偏倚风险评估。对数据进行了系统提取和分析。文献检索共获得206篇文章,其中20篇为随机对照试验。与全身麻醉等传统疼痛管理方法相比,腰丛阻滞显示出更好的疼痛缓解效果。此外,与对照组相比,腰丛阻滞减少了患者的总体阿片类药物消耗量,减少了不良反应,并促进了功能恢复,这突出了精心疼痛管理的更广泛积极影响。与连续股神经阻滞组(1.3%)相比,腰丛阻滞组术后第二天有更多患者(14.7%)能够行走超过40英尺。对包括皮质醇水平和血流动力学稳定性在内的其他参数进行了评估,结果显示相当。腰丛阻滞在骨科手术后的疼痛管理中是有效的,表现为疼痛评分更低、阿片类药物消耗量更少。此外,与全身麻醉等其他方法相比,接受腰丛阻滞治疗的患者的满意度相对更高。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/2b0f/11173339/f17f28c8ae4f/jcm-13-03194-g001.jpg

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