局部浸润麻醉对全膝关节置换术后镇痛效果的系统评价

摘要

Objective We conduct a systematic review to compare the analgesia outcomes in randomized controlled trials that compared local infiltration analgesia (LIA) with femoral nerve block (FNB) in total knee arthroplasty (TKA). Methods MEDLINE, EMBASE, CNKI, PubMed, Wanfang Data, VIP were searched for the randomized controlled trials (RCT) of comparing analgesic effect between LIA and FNB after TKA. The data extraction and quality evolution were conduc-ted according to system GRADE, including RCT assessed by meta-analysis. Results 8 studies were included. Patients un-dergoing LIA experienced a great relief of pain at 24 hours [WMD = - 1. 42, 95% CI( - 1. 93, - 0. 90), P < 0. 01] and lower opioid consumption at 24 hours [WMD = - 10. 67, 95% CI ( - 19. 50, - 1. 84), P = 0. 02]. There were no evidence of discharge time additional to that provided by femoral block [WMD = - 0. 49, 95% CI ( - 1. 40, 0. 42), P = 0. 29]. Con-clusion Local infiltration analgesia is effective in reducing pain scores at 24 hours and opioid consumption at 24 hours in pa-tients undergoing TKA. It is easy to operate with lower input costs and lower operating costs, and should be recommended as a method of postoperative analgesia in TKA.%目的：系统评价局部浸润麻醉(local infiltration anesthesia, LIA)和股神经阻滞(femoral nerve block, FNB)在全膝关节置换术(total knee arthroplasty, TKA)后的镇痛效果。方法计算机检索 MEDLINE、EMBASE、中国知网、PubMed、万方数据库、维普数据库至2014年10月为止关于 TKA 术后 LIA 和 FNB 镇痛效果比较的随机对照试验(RCT)文献。根据 GRADE 系统推荐分级方法,对纳入文献进行资料提取和质量评价,对符合纳入标准和质量标准的RCT 文献进行 meta 分析。结果最终共纳入8篇 RCT 文献。 meta 分析结果显示：TKA 术后行 LIA 镇痛能降低术后24 h 疼痛评分[WMD =-1.42,95% CI(-1.93,-0.90),P <0．01],减少术后24 h 阿片类药物使用量[WMD =-10．67,95% CI (-19.50,-1.84),P =0．02]；但无证据显示在平均住院时间方面,LIA 优于 FNB[WMD =-0.49,95% CI(-1.40,0.42),P =0．29]。结论 LIA 能降低 TKA 术后24 h 疼痛评分,减少术后24 h 阿片类药物使用量,具有良好的镇痛效果,且操作简单、经济,可作为 TKA 术后镇痛方式的强推荐。