Pain monitoring and management in a rehabilitation setting after total joint replacement.
Pain monitoring and management in a rehabilitation setting after total joint replacement.
复制标题
DOI：
10.1097/md.0000000000012484
复制
发表时间：
2018-10
期刊：
影响因子：
1.6
通讯作者：
Benedetti MG
中科院分区：
文献类型：
--
作者：
De Luca ML;Ciccarello M;Martorana M;Infantino D;Letizia Mauro G;Bonarelli S;Benedetti MG
全髋关节置换术（THR），特别是全膝关节置换术（TKR），是痛苦的外科手术。有效的术后疼痛管理可以更好，更早地恢复功能，并预防慢性疼痛。关于术后康复期间疼痛控制的研究并不常见。本研究的目的是介绍围手术期麻醉方案的结果，以及在我院骨科和康复重症病房使用的疼痛治疗方案。本观察性研究回顾性纳入了100例患者（50例THR和50例TKR）。检索所有患者的临床表中记录的静息疼痛数字评定量表（NRS），并分析手术时给予的脊髓麻醉、局部镇痛、骨科术后采用的镇痛方案、康复病房住院期间给予的镇痛治疗、术后镇痛药物的消耗，以及由于镇痛治疗引起的任何副作用。患者在平均8天内达到标准功能能力（步行至少50米和爬/下楼梯），无药物相关并发症。住院期间的平均NRS（THR组和TKR组）分别为1.3 ± 0.3和1.3 ± 0.2，最大平均NRS（TKR组和THR组）分别为1.8±0.5和1.8 ±0.6。 康复监护中急救治疗的使用与平均NRS疼痛和最大NRS疼痛相关。使用围手术期麻醉方案和疼痛治疗方案可以很好地控制疼痛。
Total hip replacement (THR) and, particularly, total knee replacement (TKR), are painful surgical procedures. Effective postoperative pain management leads to a better and earlier functional recovery and prevents chronic pain. Studies on the control of pain during the postoperative rehabilitation period are not common. The aim of this study is to present results of a perioperative anesthetic protocol, and a pain treatment protocol in use in the Orthopaedic and the Rehabilitation intensive units of our Hospital. 100 patients (50 THR and 50 TKR) were retrospectively included in this observational study. Numeric Rating Scale (NRS) for pain at rest registered in the clinical sheet was retrieved for all patients and analyzed with respect to the spinal anaesthesia given for the surgery, local analgesia, analgesia protocol adopted during the postoperative days in the Orthopaedic Unit, the antalgic treatment given during the stay within the Rehabilitation Unit, the postoperative consumption of rescue pain medication, and any collateral effect due to the analgesic therapy. Patients reached standard functional abilities (walking at least 50 meters and climbing/descending stairs) at a mean length of 8 days without medication-related complications. Mean NRS during the time of stay was 1.3 ± 0.3 for THR and 1.3 ± 0.2 for TKR) and maximum mean NRS was 1.8 ± 0.5 for TKR and 1.8 ± 0.6 for THR. The use of rescue therapy in the rehabilitation guard was correlated with the mean NRS pain and the maximum NRS pain. A very good control of pain with the perioperative anesthetic protocol and pain treatment protocol in use was obtained.