脊髓麻醉下髋关节手术患者的术后疼痛管理:评论文章

Mustafa Kamal
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引用次数: 0

摘要

背景:有多种术前、术中和术后疗法和管理方案可用于尽量减轻和控制术后疼痛。全髋关节置换术(THA)术后疼痛通常被归类为中度至重度疼痛。这可能会影响术后的恢复过程,导致活动能力延迟和住院时间延长。这就需要一种非常有效的止痛方法。一直以来,止痛都是通过硬膜外镇痛、周围神经阻滞以及通过注射或直接向脊髓注射阿片类药物来实现的。在髋部骨折的整个手术阶段,经常采用多模式镇痛与神经阻滞相结合的方法来减轻疼痛。事实证明,这种方法能有效预防并发症,并通过确保适当的疼痛控制来增强术后功能。目的:本综述旨在评估脊髓麻醉在术后疼痛治疗中的应用。方法:我们在 PubMed 和 Google Scholar 上搜索了有关术后疼痛管理、髋部手术和脊髓麻醉的信息。虽然只收录了 2009 年 10 月至 2023 年 11 月期间最新或最全面的研究,但作者还评估了相关文献的参考文献。用英语以外的语言撰写的论文因缺乏翻译来源而被取消资格。结论周围神经阻滞可有效缓解疼痛,但要充分控制疼痛,可能需要阻滞股神经(FN)、闭孔神经(ON)和外侧皮神经(LCN)。然而,这一过程具有挑战性,耗时较长,并可能导致持续的运动障碍。脊髓和肠外阿片类药物的不良反应不大,但令人不快。
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Postoperative Pain Management in Patients Undergoing Hip Surgeries with Spinal Anesthesia: Review Article
Background: There are several pre-, intra-, and post-operative therapies and management options available for minimizing and controlling postoperative pain. Postoperative pain following total hip arthroplasty (THA) is frequently categorized as moderate to severe. This can have an impact on the recovery process after surgery, leading to a delay in the ability to move and an extended stay in the hospital. A very efficient approach for pain relief is required. Historically, the management of this has been accomplished by the utilization of epidural analgesia, peripheral nerve blocks, and the administration of opioids through injection or directly into the spinal cord. Combining multimodal analgesia with nerve block methods is frequently employed to alleviate pain throughout the surgical phase of hip fractures. This approach has been demonstrated to effectively prevent complications and enhance postoperative function by ensuring proper pain control. Objective: This review aimed to assess spinal anesthesia in management of postoperative pain. Methods: We searched PubMed and Google Scholar for information on Postoperative pain management, Hip surgeries and Spinal anesthesia. Although only the most current or comprehensive study from October 2009 to November 2023 was included, the writers additionally assessed references from pertinent literature. Papers written in languages other than English have been disqualified due to lack of translation sources. Conclusion: Peripheral nerve blocks offer efficient pain relief, but to adequately manage pain, it may be required to block the femoral nerve (FN), obturator nerve (ON), and lateral cutaneous nerves (LCN). However, this procedure can be challenging, time-consuming, and may lead to lingering motor impairment. Spinal and parenteral opioids have a connection with modest but unpleasant adverse effects.
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