（优质课件）快速康复外科理念下的骨科康复.pptVIP

Effects of preemptive analgesia on pain and cytokine production in the postoperative period. Anesthesiology 2003; 98:151–5 From preemptive to preventive analgesia. Current Opinion in Anaesthesiology 2006, 19:551–55  * What is the Role of NSAIDs in Pre-emptive Analgesia?  * 骨科常见疼痛的处理专家建议 * Postoperative pain is still inadequately relieved despite substantial improvements in the knowledge of the mechanisms and treatment of pain [1]. Evidence suggests that inadequate relief of postoperative pain may result in harmful physiologic and psychologic consequences that lead to significant morbidity and mortality [2], which may delay recovery and the return to daily living [3]. In addition, the presence of postoperative symptoms, including pain, significantly contributes to patients’ dissatisfaction with their anesthesia and surgical experience [4]. Most importantly, it has been recognized that inadequately treated postoperative pain may lead to chronic pain, which is often misdiagnosed and neglected [5,6]. This article reviews the physiologic and psychologic consequences of inadequate pain relief, with an emphasis on chronic persistent postoperative pain. * 2011年，Henrik 等撰文《Why still in hospital after fast-track hip and knee arthroplasty? 》，即《为何膝/髋关节置换术后依旧无法尽早出院？》，探讨分析了影响骨科大手术后影响患者出院的因素。 他们的分析发现：疼痛、眩晕和全身乏力是影响患者出院的主要因素。 而疼痛，是骨科手术后延迟患者出院的第一因素！ * * Subacute pain and function after fast-track hip and knee arthroplasty. TKA患者在术后1个月步行时，52%报告了中度疼痛(VAS评分 30-59 mm)；16% 重度疼痛(VAS ≥60 mm) 。 这就强调出院后疼痛管理需要改善，骨科术后亚急性期疼痛尤其需要重视。 * Easily adoptable total joint arthroplasty program allows discharge home in two days. 加拿大Queen‘s University大学Kingston General Hospital医院，对200例行全关节置换术的患者进行了研究。其中常规治疗和ERAS组各100例。 结果发现： ERAS减少住院天数69小时（47小时 VS 116小时）； 减少阿片用量7.5 vs 35?mg； * Easily adoptable total joint arthroplasty program allows discharge home in two days. 此外，结果还发现：行ERAS患者组疼痛（包括静息痛和运动痛）评分更低。如图所示。 【ERAS无论静息痛还是运动痛，评分曲线均处于常规治疗组的下方，意思是评分更低】 * ASGBI《快速康复方案实施指南》建议避免使用阿片类药物，推荐使用乙酰氨基酚和非甾体类抗炎药（NSAIDS） 建议