摘要
目的总结前交叉韧带重建(anterior cruciate ligament reconstruction,ACLR)术后早期疼痛管理方式,为促进ACLR术后功能康复选择合理且有效的疼痛管理方案。方法广泛查阅近年国内外关于ACLR术后早期疼痛管理方案相关文献,并从改善术后疼痛效果方面进行综述。结果目前物理治疗和口服药物有经济、简便等优势,但改善术后疼痛效果并不佳,常需要联合静脉注射或静脉泵等方式,也是目前缓解疼痛的常用方式;但为了满足患者镇痛需求,镇痛药物使用量往往较大,增加了各种不良反应发生风险。局部浸润镇痛(local infiltration analgesia,LIA)包括关节周围或关节内注射药物,可显著改善ACLR术后早期疼痛,达到与神经阻滞相似的术后疗效;LIA可作为代替神经阻滞的一种镇痛技术,并避免神经阻滞带来的相应支配肌肉无力,从而增加术后跌倒风险。其中关节周围注射镇痛效果更优,可避免关节内注射对软骨损伤的风险。但LIA的术后镇痛效果和时效性仍有待提升,可考虑将多模式混合药物LIA(联合关节内和关节周围)联合其他疼痛干预方式,发挥协同作用,以避免单一药物或单途径给药带来的副作用和风险,有望成为缓解ACLR术后早期疼痛常用方法之一。结论关节镜下ACLR术后仍会出现早期疼痛影响患者进一步功能活动,各种镇痛方式均可获得一定疗效,但目前尚未制定统一标准,各类镇痛方式优劣有待进一步研究。
Objective To summarize the early postoperative pain management strategies for anterior cruciate ligament reconstruction(ACLR),and to select a reasonable and effective pain management plan to promote functional rehabilitation after ACLR.Methods The literature about the early postoperative pain management strategies of ACLR both domestically and internationally in recent years was extensiverly reviewed,and the effects of improving postoperative pain were reviewed.Results Currently,physical therapy and oral medication have advantages such as economy and simplicity,but the effect of improving postoperative pain is not satisfactory,often requires a combination of intravenous injection or intravenous pump,which is also a common way to relieve pain.However,in order to meet the analgesic needs of patients,the amount of analgesic drugs used is often large,which increases the incidence of various adverse reactions.Local infiltration analgesia(LIA),including periarticular or intra-articular injection of drugs,can significantly improve the early postoperative pain of ACLR,and achieve similar postoperative effectiveness as nerve block.LIA can be used as an analgesic technique instead of nerve block,and avoid the corresponding weakness of innervated muscles caused by nerve block,which increases the risk of postoperative falls.Many studies have confirmed that LIA can alleviate postoperative early pain in ACLR,especially the analgesic effects of periarticular injection are more satisfactory.It can also avoid the risk of cartilage damage caused by intra-articular injection.However,the postoperative analgesic effect and timeliness still need to be improved.It is possible to consider combining multimodal mixed drug LIA(combined with intra-articular and periarticular)with other pain intervention methods to exert a synergistic effect,in order to avoid the side effects and risks brought by single drugs or single administration route.LIA is expected to become one of the most common methods for relieving postoperative early pain in ACLR
作者
余鸿
施政良
熊波涵
李雅娟
秦艺华
董开颜
李彦林
李黎
YU Hong;SHI Zhengliang;XIONG Bohan;LI Yajuan;QIN Yihua;DONG Kaiyan;LI Yanlin;LI Li(Department of Sports Medicine,First Affiliated Hospital of Kunming Medical University,Kunming Yunnan,650032,P.R.China)
出处
《中国修复重建外科杂志》
CAS
CSCD
北大核心
2024年第2期218-225,共8页
Chinese Journal of Reparative and Reconstructive Surgery
基金
云南省重大科技专项计划项目(202102AA100015)。
关键词
前交叉韧带重建
早期疼痛
局部浸润镇痛
神经阻滞
功能康复
Anterior cruciate ligament reconstruction
early pain
local infiltration analgesia
nerve block
functional rehabilitation
