初次全膝关节置换术后疼痛的管理:一项基于一级证据的贝叶斯网络Meta分析
Management of Postoperative Pain Following Primary Total Knee Arthroplasty: A Level I Evidence-Based Bayesian Network Meta-Analysis.
作者信息
Migliorini Filippo, Betsch Marcel, Bardazzi Tommaso, Colarossi Giorgia, Elezabi Hani Ayad Mohamed, Driessen Arne, Hildebrand Frank, Pasurka Mario
机构信息
Department of Orthopaedic and Trauma Surgery, Academic Hospital of Bolzano (SABES-ASDAA), Via Lorenz Böhler 5, 39100 Bolzano, Italy.
Department of Life Sciences, Health, and Health Professions, Link Campus University, Via del Casale di San Pio V, 00165 Rome, Italy.
出版信息
Pharmaceuticals (Basel). 2025 Apr 9;18(4):556. doi: 10.3390/ph18040556.
Postoperative pain management after total knee arthroplasty (TKA) is crucial for promoting early recovery. Advances in pain management techniques have significantly improved outcomes after TKA. Recently, multimodal analgesia has emerged as a key concept in pain management following TKA, using regional anaesthesia to reduce narcotic use and minimise narcotic-related side effects. This Bayesian network meta-analysis compared different treatment options for the management of postoperative pain following primary TKA. This study was conducted following the 2020 PRISMA statement. In January 2025, all randomised controlled trials (RCTs) related to postoperative pain management following TKA were accessed. Pain reported on postoperative days (PODs) 1-3 was evaluated. Data from 7199 patients were retrieved. Of these, 63.2% (4232 of 6691) were women, and the mean age was 66.7 ± 3.1 years. The mean length of follow-up was 10.2 ± 18.3 weeks. At baseline, comparability was confirmed for age ( = 0.1), BMI ( = 0.8), and visual analogue scale (VAS, = 0.1). On POD 1, single-shot SNB/three-in-one block was associated with a lower VAS, followed by continuous intra-articular analgesia/local infiltration analgesia (LIA)/posterior capsule infiltration (PCI) and continuous femoral nerve block (FNB)/intermittent SNB. On POD 2, continuous intra-articular analgesia/LIA/PCI was associated with a lower VAS, followed by continuous FNB/PCI and single-shot femoral triangle block (FTB)/single-shot infiltration between the popliteal artery and capsule of the knee (IPACK). On POD 3, continuous ACB was associated with a lower VAS, followed by continuous intra-articular analgesia/LIA/PCI and continuous FNB/PCI. Continuous intra-articular analgesia/LIA/PCI was associated with the best pain control following primary TKA. Multimodal analgesia, which incorporates peripheral nerve blockade and periarticular injections, has become a key concept in contemporary pain management following TKA.
全膝关节置换术(TKA)后的术后疼痛管理对于促进早期恢复至关重要。疼痛管理技术的进步显著改善了TKA后的治疗效果。最近,多模式镇痛已成为TKA后疼痛管理的关键概念,采用区域麻醉来减少麻醉药物的使用并将与麻醉相关的副作用降至最低。这项贝叶斯网络荟萃分析比较了初次TKA术后疼痛管理的不同治疗方案。本研究是按照2020年PRISMA声明进行的。2025年1月,检索了所有与TKA术后疼痛管理相关的随机对照试验(RCT)。评估了术后第1 - 3天报告的疼痛情况。检索到了7199例患者的数据。其中,63.2%(6691例中的4232例)为女性,平均年龄为66.7±3.1岁。平均随访时间为10.2±18.3周。在基线时,年龄(P = 0.1)、体重指数(BMI,P = 0.8)和视觉模拟量表(VAS,P = 0.1)的可比性得到确认。在术后第1天,单次注射坐骨神经阻滞/三合一阻滞与较低的VAS相关,其次是持续关节内镇痛/局部浸润镇痛(LIA)/后关节囊浸润(PCI)和持续股神经阻滞(FNB)/间歇性坐骨神经阻滞。在术后第2天,持续关节内镇痛/LIA/PCI与较低的VAS相关,其次是持续FNB/PCI和单次注射股三角阻滞(FTB)/单次注射腘动脉与膝关节囊之间浸润(IPACK)。在术后第3天,持续踝部阻滞与较低的VAS相关,其次是持续关节内镇痛/LIA/PCI和持续FNB/PCI。持续关节内镇痛/LIA/PCI与初次TKA后最佳的疼痛控制相关。结合周围神经阻滞和关节周围注射的多模式镇痛已成为当代TKA后疼痛管理的关键概念。