大肢体截肢围手术期疼痛处理-系统叙述混合回顾。

IF 3.2 2区 医学 Q2 CLINICAL NEUROLOGY
Floris V Raasveld, Seamus P Caragher, Nicolas Kumar, Carla H Lehle, Ahish Chitneni, Ian L Valerio, Kyle R Eberlin, David Hao
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引用次数: 0

摘要

截肢后疼痛,包括残肢痛(RLP)和幻肢痛(PLP),可以影响手术的结果,并影响生活质量。急性截肢后疼痛的有效管理需要多学科的方法,外科和麻醉团队之间的合作,以优化疼痛管理。我们进行了一项系统叙述的混合回顾,以评估和报告各种干预措施在截肢手术围手术期疼痛管理中的有效性。方法:检索MEDLINE、Embase、CENTRAL和ClinicalTrials.gov数据库,以评估介入和/或药理学方法对大肢截肢手术围手术期疼痛的控制。收集的数据包括治疗方案、平均剂量和/或治疗持续时间,以及报告的疼痛结果。结果:在27项评估干预措施的研究中,8项研究涉及轴向或神经周围镇痛,16项研究关注周围神经阻滞(PNB), 2项研究周围神经刺激器(PNS), 1项研究经皮神经电刺激。术前硬膜外镇痛与术后疼痛发生率降低相关。PNS、PNB和导管输注均可有效控制术后疼痛。氯胺酮在治疗截肢后疼痛中的作用产生了不同的结果,而其他药物,如丙戊酸和加巴喷丁,疗效有限。结论:虽然有许多疼痛干预措施可用,但没有一种方法被证明是优越的。多模式策略,包括pnb,术前疼痛控制,以及潜在的氯胺酮,似乎提供了最全面的疼痛管理策略。需要进一步的长期前瞻性研究来完善和优化大肢截肢手术的疼痛管理技术。证据等级:iii级-系统评价。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Perioperative Pain Management for Major Limb Amputation - A Systematic-Narrative Hybrid Review.

Introduction: Post-amputation pain, including residual limb pain (RLP) and phantom limb pain (PLP), can affect the outcome of surgery and have an impact on quality of life. Effective management of acute post-amputation pain requires a multidisciplinary approach with collaboration among the surgical and anesthesia teams to optimize pain management. A systematic-narrative hybrid review was conducted to assess and report the effectiveness of various interventions in perioperative pain management for amputation surgery.

Methods: MEDLINE, Embase, CENTRAL, and ClinicalTrials.gov databases were searched for studies evaluating interventional and/or pharmacological approaches to managing perioperative pain in major extremity amputation surgery. The data collected included treatment options, average dosage and/or duration of treatments, and reported pain outcomes.

Results: Of the 27 studies evaluating interventions, 8 addressed neuraxial or perineural analgesia, 16 focused on peripheral nerve blocks (PNB), 2 examined peripheral nerve stimulators (PNS), and 1 investigated transcutaneous electrical nerve stimulation. Preoperative epidural analgesia was associated with a reduced incidence of postoperative pain. PNS, PNB, and catheter-based infusions were found to be effective in managing postoperative pain. The role of ketamine in treating post-amputation pain yielded mixed results, while other pharmacological agents, such as valproic acid and gabapentin, demonstrated limited efficacy.

Conclusions: While numerous pain interventions are available, no single approach has been shown to be superior. A multimodal strategy, incorporating PNBs, preoperative pain control, and potentially ketamine, appears to provide the most comprehensive pain management strategy. Further long-term prospective studies are required to refine and optimize pain management techniques for major extremity amputation surgery.

Level of evidence: III-Systematic reviews.

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来源期刊
Current Pain and Headache Reports
Current Pain and Headache Reports CLINICAL NEUROLOGY-
CiteScore
6.10
自引率
2.70%
发文量
91
审稿时长
6-12 weeks
期刊介绍: This journal aims to review the most important, recently published clinical findings regarding the diagnosis, treatment, and management of pain and headache. By providing clear, insightful, balanced contributions by international experts, the journal intends to serve all those involved in the care and prevention of pain and headache. We accomplish this aim by appointing international authorities to serve as Section Editors in key subject areas, such as anesthetic techniques in pain management, cluster headache, neuropathic pain, and migraine. Section Editors, in turn, select topics for which leading experts contribute comprehensive review articles that emphasize new developments and recently published papers of major importance, highlighted by annotated reference lists. An international Editorial Board reviews the annual table of contents, suggests articles of special interest to their country/region, and ensures that topics are current and include emerging research. Commentaries from well-known figures in the field are also provided.
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