对一家三级骨科医院在全身麻醉下进行髋关节置换手术的 ERAS 术后疼痛方案有效性的回顾性研究

Shashidhar Dabbeghatta
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摘要

:增强术后恢复(ERAS)概念是由 Henrik Kehlet 领导的一组欧洲外科医生于 1997 年首次提出的。提出ERAS概念的目的是针对延迟术后恢复的因素,如器官功能障碍、手术压力,并改善手术效果和住院时间。这种方法的主要目的是通过在一个协调的临床路径中实施多学科、多干预措施来减少身体对手术压力的反应。该方案首先在结肠直肠手术中实施,目的是通过减少术后回肠淤积来提高术后恢复率,从而减少费用和住院时间。自该计划成功推出以来,ERAS 已被用于其他几个专科,如乳腺、泌尿、妇科和肌肉骨骼手术。在骨科手术中,尤其是择期髋关节和膝关节置换术中,ERAS 已成为重要手段。美国国家医疗服务系统(NHS)三级骨科医院进行了一项回顾性审计,以确定 ERAS 术后疼痛治疗方案对在全身麻醉下进行初级髋关节置换术的患者的有效性。定性和定量数据包括住院时间和 ERAS 疼痛方案的违约率。ERAS达标组的平均住院时间为3.95天,ERAS违约组为4.7天,总住院时间增加了16%。ERAS路径提倡使用阿片类药物稀释的多模式镇痛来控制疼痛,外周神经阻滞(单次/连续)和局部浸润/关节周围注射已成为阿片类药物的更好替代品,可有效控制术后即刻疼痛。有明确的证据表明,这些技术可以改善患者的治疗效果,缩短住院时间。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
A retrospective review of effectiveness of ERAS post-operative pain protocol in hip replacement surgeries under general anaesthesia at a tertiary orthopaedic hospital
: The concept of enhanced recovery after surgery (ERAS) was first introduced in 1997 by a group of European surgeons led by Henrik Kehlet. The ERAS concept was introduced to target the factors delaying post-operative recovery such as organ dysfunction, surgical stress and to improve the surgical outcomes and length of stay at the hospital. The primary aim of this approach is to reduce the body’s response to surgical stress by implementing a multidisciplinary, multitude of interventions in a coordinated clinical pathway. It was first implemented for colorectal surgeries to improve the post-surgical recovery rates by decreasing the post-operative ileus and thereby reducing the cost and length of hospital stay. Since the successful introduction of the program, ERAS has been used in several other specialties such as breast, urological, gynaecological, and musculoskeletal procedures. Off-late ERAS has become important in orthopaedic surgeries, particularly elective hip and knee arthroplasties. A retrospective review audit was conducted at tertiary Orthopaedic NHS Hospital to determine the effectiveness of ERAS post-operative pain protocol in patients who had primary hip arthroplasty under general anaesthesia. The qualitative and quantitative data included the length of stay at the hospital and default rates in the ERAS pain protocol. The length of stay at the hospital in ERAS compliant group was a mean of 3.95 days and in ERAS default group was 4.7 days, showing an increase of 16% in the total duration. The IV PCA group had 4.6 days of the average length of stay.: ERAS pathway advocates for using opioid-sparing multimodal analgesia to control pain, peripheral nerve blocks (single-shot/continuous), and local infiltration /peri-articular injections have become a better alternative to opioids in controlling the immediate post-surgical pain effectively. There is clear evidence to suggest that these techniques can improve patient outcomes and decrease the duration of stay.
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