Pain Management for Ambulatory Arthroscopic Anterior Cruciate Ligament Reconstruction: Evidence-Based Recommendations From the Society for Ambulatory Anesthesia
Pain Management for Ambulatory Arthroscopic Anterior Cruciate Ligament Reconstruction: Evidence-Based Recommendations From the Society for Ambulatory Anesthesia
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DOI：
10.1213/ane.0000000000003976
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发表时间：
2019-04-01
影响因子：
5.7
通讯作者：
Joshi, Girish P.
中科院分区：
文献类型：
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作者：
Abdallah, Faraj W.;Brull, Richard;Joshi, Girish P.
即使使用非阿片类口服镇痛药（如对乙酰氨基酚和非甾体抗炎药），动态关节镜前交叉韧带重建也会伴有中度疼痛。区域镇痛可以补充非阿片类口服镇痛药并减少术后阿片类药物的需求，但前交叉韧带重建中区域镇痛技术的选择仍存在争议。股神经阻滞、内收肌管阻滞和局部滴注镇痛都已被提出，并得到了随机对照试验的一些证据的支持。因此，接受前交叉韧带重建的患者的区域镇痛实践仍然很复杂。已发表的系统评价用于确定区域镇痛方式，该方式将在非阿片类多模式镇痛策略的设置中提供镇痛功效和相关潜在风险之间的平衡。根据现有证据，在门诊关节镜前交叉韧带重建术后 24 小时内，局部滴注镇痛作为多模式镇痛技术的一个组成部分，可以在镇痛效果和相关风险之间实现最佳平衡（强烈推荐，中等证据水平）。在缺乏局部滴注镇痛的情况下，临床医生可能会使用收肌管阻滞或股神经阻滞（弱推荐，证据水平弱）。这些建议已得到动态麻醉协会的认可并得到其董事会的批准。
Ambulatory arthroscopic anterior cruciate ligament reconstruction is associated with moderate pain, even when nonopioid oral analgesics such as acetaminophen and nonsteroidal anti-inflammatory drugs are used. Regional analgesia can supplement nonopioid oral analgesics and reduce postoperative opioid requirements, but the choice of regional analgesia technique for anterior cruciate ligament reconstruction remains controversial. Femoral nerve block, adductor canal block, and local instillation analgesia have all been proposed and are supported by some evidence from randomized controlled trials. Consequently, regional analgesia practice in patients undergoing anterior cruciate ligament reconstruction remains mixed. Published systematic reviews were used to identify the regional analgesia modality that would provide a balance between analgesic efficacy and associated potential risks in the setting of nonopioid multimodal analgesic strategies. Based on the evidence available, local instillation analgesia provides the best balance of analgesic efficacy and associated risks (strong recommendation, moderate level of evidence) when used as a component of multimodal analgesic technique in the first 24 hours after outpatient arthroscopic anterior cruciate ligament reconstruction. In the absence of local instillation analgesia, clinicians might use adductor canal block or femoral nerve block (weak recommendation, weak level of evidence). These recommendations have been endorsed by the Society of Ambulatory Anesthesia and approved by its board of directors.