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加速康复外科(enhanced recovery after surgery,ERAS)理念的核心是在围术期应用已证实有效的方法减少手术应激,降低疼痛与并发症的发生率,加快功能康复,提高患者满意度。而疼痛和睡眠障碍是影响患者加速康复的重要原因。基于国家卫生和计划生育委员会(简称"国家卫计委")公益性行业科研专项《关节置换术安全性与效果评价》项目组数据库大样本数据分析,遵循循证医学原则,经全国专家组反复讨论,编辑整理完成本共识,供广大骨科医师在临床工作中参考。本共识主要分为两大部分,前一部分为髋、膝关节置换术围术期疼痛的管理,重点包括疼痛的评估,疼痛管理的目的、原则和疼痛管理的常用方法以及疼痛管理流程;后一部分介绍围术期睡眠障碍的分类、原因、临床表现和境遇性失眠、慢性失眠及焦虑型失眠的诊断和处理。
Abstract：The enhanced recovery after surgery(ERAS) aims to reduce surgical stress and incidences of pain and complications, enhance functional rehabilitation, and improve patients' satisfaction by using approved efficient methods in perioperative period. Pain and insomnia are obstacles for enhanced recovery. Based on the database of the project group for the"National Health and Family Planning Commission's public-benefit project: the safety and effect assessment of joint arthroplasty"and evidence-based medicine, we compile this consensus and hope it can give some help to orthopedists. This consensus contains two parts. The first part is about pain management during perioperative period of TKA and THA, which mainly discuss pain evaluation, goal, principle, common method and procedure of pain management. The second part introduces perioperative insomnia classification, reason, clinical manifestation and the diagnosis and treatment for conditioned insomnia,chronic insomnia and anxiety insomnia.
[1]Foley KM,Posner JB.Pain and its management.In:Wyngaarden JB,Smith LH.Cecil textbook of medicine.18th ed.Philadelphia:WB Saunders Company,1988:104-112.
[2]Philips WJ,Currier BL.Analgesic pharmacology:I.Neurophysiology.J Am Acad Orthop Surg,2004,12(4):213-220.
[3]中华医学会骨科学分会.骨科常见疼痛的处理专家建议.中华骨科杂志,2008,28(1):78-81.
[4]Parvizi J,Miller AG,Gandhi K.Multimodal pain management after total joint arthroplasty.J Bone Joint Surg Am,2011,93(11):1075-1084.
[5]王浩洋,康鹏德,裴福兴,等.全髋关节置换术后多模式镇痛的有效性及安全性.中国矫形外科杂志,2013,21(10):976-980.
[6]Mc Cartney CJ,Nelligan K.Postoperative pain management after total knee arthroplasty in elderly patients:treatment options.Drugs Aging,2014,31(2):83-91.
[7]Buvanendran A,Kroin JS,Tuman KJ,et al.Effects of perioperative administration of a selective cyclooxygenase 2 inhibitor on pain management and recovery of function after knee replacement:a randomized controlled trial.JAMA,2003,290(18):2411-2418.
[8]Huang YM,Wang CM,Wang CT,et al.Perioperative celecoxib administration for pain management after total knee arthroplasty-a randomized,controlled study.BMC Musculoskelet Disord,2008,9:77.
[9]沈彬,唐新,杨静,等.围术期口服塞来昔布对全膝关节置换术后疼痛和功能康复的近期影响和安全性观察.中华外科杂志,2009,47(2):116-119.
[10]Bourne MH.Analgesics for orthopedic postoperative pain.Am J Orthop(Belle Mead NJ),2004,33(3):128-135.
[11]Casati A,Ostroff R,Casimiro C,et al.72-hour epidural infusion of 0.125%levobupivacaine following total knee replacement:a prospective,randomized,controlled,multicenter evaluation.Acta Biomed,2008,79(1):28-35.
[12]F?rster JG,Rosenberg PH.Small dose of clonidine mixed with low-dose ropivacaine and fentanyl for epidural analgesia after total knee arthroplasty.Br J Anaesth,2004,93(5):670-677.
[13]Choi PT,Bhandari M,Scott J,et al.Epidural analgesia for pain relief following hip or knee replacement.Cochrane Database Syst Rev,2003,(3):CD003071.
[14]de Lima E Souza R,Correa CH,Henrigues MD,et al.Single-injection femoral nerve block with 0.25%ropivacaine or 0.25%bupivacaine for postoperative analgesia after total knee replacement or anterior cruciate ligament reconstruction.J Clin Anesth,2008,20(7):521-527.
[15]Richman JM,Liu SS,Courpas G,et al.Does continuous peripheral nerve block provide superior pain control to opioids?A meta-analysis.Anesth Analg,2006,102(1):248-257.
[16]Fowler SJ,Symons J,Sabato S,et al.Epidural analgesia compared with peripheral nerve blockade after major knee surgery:a systematic review and meta-analysis of randomize trials.Br J Anaesth,2008,100(2):154-164.
[17]Fu P,Wu Y,Wu H,et al.Efficacy of intra-articular cocktail analgesic injection in total knee arthroplasty-a randomized controlled trial.Knee,2009,16(4):280-284.
[18]Busch CA,Shore BJ,Bhandari R,et al.Efficacy of periarticular multimodal drug injection in total knee arthroplasty.A randomized trial.J Bone Joint Surg Am,2006,88(5):959-963.
[19]Mullaji A,Kanna R,Shetty GM,et al.Efficacy of periarticular injection of bupivacaine,fentanyl,and methylprednisolone in total knee arthroplasty:a prospective,randomized trial.J Arthroplasty,2010,25(6):851-857.
[20]康鹏德,王浩洋,沈彬,等.加入局部浸润镇痛的多模式镇痛在全膝关节置换中的应用.中华骨科杂志,2013,33(3):246-251.
基本信息:
DOI：
中图分类号:R687.4
引用信息:
[1]沈彬,翁习生,廖刃等.中国髋、膝关节置换术加速康复——围术期疼痛与睡眠管理专家共识[J].中华骨与关节外科杂志,2016,9(02):91-97.
基金信息: