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首页> 外文期刊>Current opinion in anaesthesiology >Wound/intra-articular infiltration or peripheral nerve blocks for orthopedic joint surgery: Efficacy and safety issues
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Wound/intra-articular infiltration or peripheral nerve blocks for orthopedic joint surgery: Efficacy and safety issues

机译：骨科关节手术的伤口/关节内浸润或周围神经阻滞：疗效和安全性问题

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PURPOSE OF REVIEW: Pain following arthroplasty is managed utilizing continuous peripheral nerve blocks (PNB) or local infiltration analgesia (LIA). The current economic climate in many countries requires discharge from the hospital within a couple of days following arthroplasty. Earlier studies had documented the efficacy of LIA for lower limb arthroplasty with preserved motor function and early rehabilitation, but some recent studies fail to confirm such a benefit. The motor block associated with PNB can be challenging with well tolerated rehabilitation. This review will discuss the efficacy and safety of these two analgesic techniques. RECENT FINDINGS: LIA facilitates early rehabilitation with total knee joint arthroplasty but such a benefit may not be obvious with total hip arthroplasty in the presence of multimodal analgesia. LIA data are very diverse depending on drugs injected, site of catheters, drug dosing and use of adjuvants. Chondrolysis documented with shoulder surgery with LIA is not a concern as there is no cartilage left with arthroplasty except in uniknees. Unpredictable motor weakness poses challenge with lower limb nerve blocks. SUMMARY: More rigorously conducted large-scale comparative studies are required to document the relative safety and efficacy of these two analgesic techniques. Standardization of infiltration techniques, catheter location, drugs and dosing are much needed. LIA with extended duration long-acting local anesthetic is in its infancy and may be an alternative to PNBs.
机译：审查的目的：关节置换术后的疼痛可通过连续性周围神经阻滞（PNB）或局部浸润镇痛（LIA）来控制。在许多国家，当前的经济气候要求在关节置换术后几天之内从医院出院。较早的研究已经证明LIA在保留运动功能和早期康复的情况下对下肢关节置换术的疗效，但是最近的一些研究未能证实这种益处。与PNB相关的运动阻滞对于良好耐受的康复可能具有挑战性。本文将讨论这两种止痛技术的有效性和安全性。最近的发现：LIA促进了全膝关节置换术的早期康复，但是在多模式镇痛的情况下，全髋关节置换术的好处可能并不明显。 LIA数据非常不同，具体取决于注射的药物，导管的位置，药物剂量和佐剂的使用。 LIA进行的肩部手术记录的骨质疏松症无所谓，因为除单膝关节外，没有其他人工关节置换软骨。不可预测的运动无力对下肢神经阻滞构成挑战。摘要：需要更严格地进行大规模的比较研究，以记录这两种镇痛技术的相对安全性和有效性。非常需要浸润技术，导管位置，药物和剂量的标准化。持续时间长的长效局麻药的LIA尚处于初期阶段，可能是PNB的替代药物。

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