全膝关节置换应用股神经阻滞镇痛与自控静脉镇痛的系统评价

背景：目前对全膝关节置换围手术期采用何种镇痛方法的效果差异存在争议. 目的：系统评价全膝关节置换术中应用股神经阻滞镇痛与患者自控静脉镇痛的疗效和安全性. 方法：全面搜索国内外关于全膝关节置换中应用股神经阻滞镇痛和患者自控静脉镇痛的随机对照研究资料,按照既定的纳入、排除标准,核定检出符合评价标准的文献,提取所需研究数据,采用RevMan 5.0.18软件进行Meta分析.评价指标包括术后24,48 h静息和活动时的目测类比评分、恶心呕吐胃肠道症状发生率、嗜睡等镇静过度发生率以及患者满意率. 结果与结论：纳入随机对照研究19篇,样本共计952膝,股神经阻滞组和患者自控静脉镇痛组分别为481膝和471膝.荟萃分析加权后,股神经阻滞与患者自控静脉镇痛相比,术后24,48 h静息和活动目测类比评分均较低（P 〈0.05）,无论是单次股神经阻滞还是连续股神经阻滞,差异均有显著性意义.在并发症发生率方面,股神经阻滞术后恶心呕吐及嗜睡发生率低于患者自控静脉镇痛（P 〈0.05）.结果提示,全膝关节置换术中采用股神经阻滞镇痛,无论是镇痛效果还是并发症发生率都优于患者自控静脉镇痛,且股神经阻滞镇痛患者满意度较高.但二者间的比较仍需大规模多中心的随机对照试验来进一步研究.

Systemic evaluation of femoral nerve block analgesia and patient controlled intravenous analgesia in pain control after total knee arthroplasty

BACKGROUND：There is controversial on perioperative analgesic options of total knee arthroplasty. OBJECTIVE：To assess the efficacy and safety of femoral nerve block analgesia and patient control ed intravenous analgesia in total knee arthroplasty. METHODS：Randomized control ed trials on the application of femoral nerve block analgesia and patient control ed intravenous analgesia in total knee arthroplasty, and the literatures that met the evaluation criteria were included according to the inclusion and exclusion criteria in order to extract the required research data. The Meta-analysis was performed with RevMan 5.0.18 software. The evaluation indicators included the visual analog scale during postoperative 24 hours, 48 hours resting and activities period, the incidence rate of nausea, vomiting and gastrointestinal symptoms, as wel as the incidence rate of lethargy and other excessive sedation and the satisfaction rate. RESULTS AND CONCLUSION：Nineteen randomized control ed trials with 952 knees were included. There were 481 knees in the femoral nerve block analgesia group and 471 knees in the patient control ed intravenous analgesia group. After weighted Meta-analysis, the visual analog scale during postoperative 24 hours and 48 hours resting and activities period in the femoral nerve block analgesia group was lower than that in the patient control ed intravenous analgesia group （P〈0.05）. There were significant differences in single femoral nerve block and continuous femoral nerve block. For the incidence of complications, the incidence rate of nausea, vomiting and gastrointestinal symptoms in the femoral nerve block analgesia group were lower than those in the patient control ed intravenous analgesia group （P〈0.05）. Femoral nerve block analgesia was superior to patient control ed intravenous analgesia in postoperative analgesia and incidence of complications for patient having total knee arthroplasty, and the femoral nerve block analgesia has higher satisfaction. However, large-scale multi-center randomized control ed trials are required to evaluate the difference between femoral nerve block analgesia and patient control ed intravenous analgesia.