膝关节置换后的疼痛管理
作者：郭晓东
【期刊名称】中国组织工程研究 【年(卷),期】2015(000)048 【总页数】1
A successful TKA depends on multiple factors, such as patient and prosthesis selection, surgical technique,pain management and functional exercise. Functional exercise after TKA is a painful, but necessary process, which is impartible part of this procedure. (Figure 1) How to avoid this problem effecttively is what surgeons seek to: Per-operative
Preemptive
analgesia[1]Intra-operative
Drug
cocktail
therapy[2]Post-operative Cryotherapy[3] Muscle spasm-pain-muscle spasm
Surgical trauma induces effusion and stress. These are difficult to avoid and can lead to muscle spasm[4]. Pain results in sever muscle spasm. Muscle spasm aggravates pain.
Muscle spasm-pain-spasm cycleAt present, eperisone is usually used for patients with acute or chronic musculoskeletal spasm associated with low back pain (LBP).
Eperisone is an effective and safe protocol for pain management in patients undergoing TKA. That can statically significantly decrease postoperative VAS pain scores on ambulation and morphine
consumption with improving postoperative ROM for TKA patients. Oral supplement of adenosine triphosphate (ATP) is a potential option. A total of 244 subjects were randomized to receive 120 mg ATP or placebo each day for 4 weeks. Significant differences in quadriceps strength, pain scores at postoperative days 7, 14, 21, and 28 and total opioid consumption were detected. It follows that oral supplement of ATP could benefit patients recovering from TKA.
Pain-poor sleep-more pain cyclePatients in early stage after TKA tend to suffer from sleep problem. The study conducted by O'Brien MJ indicated that insufficient sleep (4 hours or less) could lead to deterioration in performance, sustained attention, and concentration of subjects.
Pain-poor sleep-more pain cycle 40 spasm cycle
Pain directly leads to sleep disrupttion or even deprivation and, in turn, poor-quality sleep aggravates pain sensation. There exsit a vicious circle: pain-poor-quality sleep -intensified pain-even poorer-quality sleep. Pain-poor sleep-more pain cycleImproved sleep quality due to short-term application of zolpidem helped hasten patients’ recovery and increase active ROM effectively. Quality of life in hospital was significantly improved. Such an application significantly decreased postoperative VAS pain scores at rest, ambulation, night and reduced analgesics and antemetic consumption. We seek to methods that
benefit recovery form TKA. Less pain More safety Recovery sooner More satisfation Summary
Improved sleep quality and quadricceps muscle strength benefit recovery from TKA. We should perfect functional exercise continuously.
膝关节置换后的疼痛管理
