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针对隐神经髌下支缓解急慢性膝关节疼痛患者的疼痛:随机对照试验和队列研究的系统评价

Targeting the Infrapatellar Branch of the Saphenous Nerve for Pain Relief in Patients With Acute or Chronic Knee Pain: A Systematic Review of Randomized Controlled Trials and Cohort Studies.

作者信息

Li Qiangqiang, Aierken Aikeremu, Qin Jianghui, Chen Dongyang, Jiang Qing

机构信息

State Key Laboratory of Pharmaceutical Biotechnology, Division of Sports Medicine and Adult Reconstructive Surgery, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, Jiangsu, People's Republic of China.

Branch of National Clinical Research Center for Orthopedics, Sports Medicine and Rehabilitation, Nanjing, Jiangsu, People's Republic of China.

出版信息

Orthop Surg. 2025 Apr;17(4):981-989. doi: 10.1111/os.14349. Epub 2025 Feb 11.

Abstract

Blocking the infrapatellar branch of the saphenous nerve (IPBSN) can provide analgesic benefits for patients with postoperative acute pain or chronic pain, with minimal adverse effects. To evaluate the analgesic efficacy and potential adverse events associated with IPBSN block in patients suffering from acute or chronic knee pain. We conducted a systematic review across PubMed, Cochrane, Web of Science, and Embase to identify all relevant randomized controlled trials (RCTs) and cohort studies according to predefined selection criteria. The study quality of the RCTs was evaluated using the Cochrane risk of bias assessment tool, while cohort studies were assessed using the ROBINS-I risk of bias tool. The primary outcomes measured were pain intensity and opioid consumption following the nerve block. A total of eight studies were included in this systematic review, encompassing 613 subjects with 276 participants in the control group and 337 participants in the IPBSN block group. The level of evidence was rated high for the RCTs and moderate for the cohort studies. The nerve block was administrated either through the injection of local anesthetic or percutaneous cryoneurolysis targeting the IPBSN. The results indicated that the IPBSN block significantly improved pain relief and reduced opioid consumption in patients with acute postoperative or chronic pain, with no significant difference in the rate of adverse events relating to the procedures or device. The IPBSN block holds promise for improving pain relief and reducing opioid consumption. However, further well-designed randomized controlled trials are needed to confirm these results.

摘要

阻滞隐神经髌下支(IPBSN)可为术后急性疼痛或慢性疼痛患者提供镇痛效果,且不良反应极小。为评估IPBSN阻滞对急性或慢性膝关节疼痛患者的镇痛疗效及潜在不良事件。我们在PubMed、Cochrane、科学网和Embase上进行了系统综述,以根据预定义的选择标准确定所有相关的随机对照试验(RCT)和队列研究。使用Cochrane偏倚风险评估工具评估RCT的研究质量,而队列研究则使用ROBINS-I偏倚风险工具进行评估。测量的主要结果是神经阻滞后的疼痛强度和阿片类药物消耗量。本系统综述共纳入八项研究,涵盖613名受试者,其中对照组276人,IPBSN阻滞组337人。RCT的证据水平被评为高,队列研究的证据水平被评为中等。神经阻滞通过注射局部麻醉剂或针对IPBSN的经皮冷冻神经lysis进行。结果表明,IPBSN阻滞显著改善了急性术后或慢性疼痛患者的疼痛缓解并减少了阿片类药物消耗,与操作或设备相关的不良事件发生率无显著差异。IPBSN阻滞有望改善疼痛缓解并减少阿片类药物消耗。然而,需要进一步设计良好的随机对照试验来证实这些结果。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/5e00/11962285/d11a19b58e66/OS-17-981-g003.jpg

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