Peripheral nerve block anesthesia/analgesia for patients undergoing primary hip and knee arthroplasty: recommendations from the International Consensus on Anesthesia-Related Outcomes after Surgery (ICAROS) group based on a systematic review and meta-analysis of current literature

被引：115

作者：

Memtsoudis, Stavros G. ^{[1
,2
]}

Cozowicz, Crispiana ^{[3
]}

Bekeris, Janis ^{[3
]}

Bekere, Dace ^{[3
]}

Liu, Jiabin ^{[1
,2
]}

Soffin, Ellen M. ^{[1
,2
]}

Mariano, Edward R. ^{[4
,5
]}

Johnson, Rebecca L. ^{[6
]}

Go, George ^{[1
]}

Hargett, Mary J. ^{[1
]}

Lee, Bradley H. ^{[1
,2
]}

Wendel, Pamela ^{[1
,2
]}

Brouillette, Mark ^{[1
,2
]}

Kim, Sang Jo ^{[1
,2
]}

Baaklini, Lila ^{[1
,2
]}

Wetmore, Douglas S. ^{[1
,2
]}

Hong, Genewoo ^{[1
,2
]}

Goto, Rie ^{[1
]}

Jivanelli, Bridget ^{[1
]}

Athanassoglou, Vassilis ^{[7
]}

Argyra, Eriphili ^{[8
]}

Barrington, Michael John ^{[9
]}

Borgeat, Alain ^{[10
]}

De Andres, Jose ^{[11
]}

El-Boghdadly, Kariem ^{[12
]}

Elkassabany, Nabil M. ^{[13
]}

Gautier, Philippe ^{[14
]}

Gerner, Peter ^{[15
]}

Della Valle, Alejandro Gonzalez ^{[3
]}

Goytizolo, Enrique ^{[16
,17
]}

Guo, Zhenggang

Hogg, Rosemary ^{[18
]}

Kehlet, Henrik ^{[19
]}

Kessler, Paul ^{[20
]}

Kopp, Sandra ^{[21
]}

Lavand'homme, Patricia

Macfarlane, Alan ^{[22
]}

MacLean, Catherine ^{[23
,24
]}

Mantilla, Carlos ^{[25
,26
]}

McIsaac, Dan ^{[27
]}

McLawhorn, Alexander ^{[27
]}

Neal, Joseph M. ^{[16
,17
]}

Parks, Michael ^{[28
,29
]}

Parvizi, Javad ^{[30
]}

Peng, Philip ^{[31
]}

Pichler, Lukas ^{[32
]}

Poeran, Jashvant ^{[33
]}

Poultsides, Lazaros ^{[34
]}

Schwenk, Eric S. ^{[35
]}

Sites, Brian D. ^{[36
]}

机构：

[1] Hosp Special Surg, Dept Anesthesiol Crit Care & Pain Management, 535 E 70th St, New York, NY 10021 USA

[2] Weill Cornell Med Coll, Dept Anesthesiol Crit Care & Pain Management, New York, NY USA

[3] Paracelsus Med Private Univ, Dept Anesthesiol Perioperat Med & Intens Care Med, Salzburg, Austria

[4] VA Palo Alto Hlth Care Syst, Anesthesiol & Perioperat Care Serv, Palo Alto, CA USA

[5] Stanford Univ, Sch Med, Dept Anesthesiol Perioperat & Pain Med, Stanford, CA 94305 USA

[6] Mayo Clin, Dept Anesthesiol & Perioperat Med, Rochester, MN USA

[7] Oxford Univ Hosp NHS Fdn Trust, Nuffield Dept Anaesthet, Oxford, England

[8] Aretaie Univ Hosp, Fac Med, Athens, Greece

[9] Oregon Hlth & Sci Univ, Dept Anesthesiol & Perioperat Med, Portland, OR 97201 USA

[10] Balgrist Univ Hosp, Anesthesiol, Zurich, Switzerland

[11] Univ Valencia, Gen Hosp, Anesthesia Crit Care & Multidisciplinary Pain Man, Valencia, Spain

[12] Univ Valencia, Sch Med, Surg Specialties Dept, Anesthesia Unit, Valencia, Spain

[13] Guys & St Thomas NHS Fdn Trust, Anaesthesia, London, England

[14] Univ Penn, Anesthesiol & Crit Care, Philadelphia, PA 19104 USA

[15] Clin St Anne St Remi, Dept Anesthesiol & Resuscitat, Brussels, Belgium

[16] Hosp Special Surg, Dept Orthoped Surg, 535 E 70th St, New York, NY 10021 USA

[17] Weill Cornell Med Coll, Dept Orthoped Surg, New York, NY USA

[18] Peking Univ, Shougang Hosp, Dept Anesthesiol, Beijing, Peoples R China

[19] Belfast Hlth & Social Care Trust, Dept Anaesthesia, Belfast, Antrim, North Ireland

[20] Rigshosp, Dept Clin Med, Copenhagen, Denmark

[21] Univ Hosp Frankfurt, Anaesthesiol Intens Care Med & Pain Therapy, Frankfurt, Germany

[22] Univ Catholic Louvain, St Luc Hosp, Anesthesiol, Brussels, Belgium

[23] Glasgow Royal Infirm, Sch Med Dent & Nursing, Glasgow, Lanark, Scotland

[24] Stobhill Ambulatory Hosp, Glasgow, Lanark, Scotland

[25] Hosp Special Surg, Ctr Advancement Value Musculoskeletal Care, 535 E 70th St, New York, NY 10021 USA

[26] Weill Cornell Med Coll, Ctr Advancement Value Musculoskeletal Care, New York, NY USA

[27] Ottawa Hosp, Dept Anesthesiol & Pain Med, Ottawa, ON, Canada

[28] Virginia Mason Med Ctr, Anesthesiol, Seattle, WA 98101 USA

[29] Virginia Mason Med Ctr, Benaroya Res Inst, Seattle, WA 98101 USA

[30] Hosp Special Surg, Orthoped Surg, 535 E 70th St, New York, NY 10021 USA

[31] Rothman Orthopaed Inst, Orthoped Surg, Philadelphia, PA USA

[32] Univ Hlth Network, Toronto Western Hosp, Anesthesia, Toronto, ON, Canada

[33] Icahn Sch Med Mt Sinai, Orthopaed Populat Hlth Sci & Policy, New York, NY 10029 USA

[34] New York Langone Orthopaed Hosp, Dept Orthopaed Surg, New York, NY USA

[35] Thomas Jefferson Univ, Sidney Kimmel Med Coll, Dept Anesthesiol, Philadelphia, PA 19107 USA

[36] Dartmouth Med Sch, Anesthesiol, Hanover, NH USA

[37] Med Univ Innsbruck, Dept Anesthesiol & Intens Care, Innsbruck, Austria

[38] Thomas Jefferson Univ, Sidney Kimmel Med Coll, Dept Anesthesiol, Philadelphia, PA 19107 USA

[39] Univ Illinois Hosp & Hlth Sci Syst, Dept Anesthesiol, Chicago, IL USA

来源：

REGIONAL ANESTHESIA AND PAIN MEDICINE | 2021年 / 46卷 / 11期

关键词：

LOCAL INFILTRATION ANALGESIA; ADDUCTOR CANAL BLOCK; POSTOPERATIVE PAIN MANAGEMENT; CONTROLLED EPIDURAL ANALGESIA; LUMBAR PLEXUS BLOCK; RANDOMIZED CONTROLLED-TRIAL; ILIACA COMPARTMENT BLOCK; FEMORAL NERVE; PERIARTICULAR INJECTION; REGIONAL ANESTHESIA;

D O I：

10.1136/rapm-2021-102750

中图分类号：

R614 [麻醉学];

学科分类号：

100217 ;

摘要：

Background Evidence-based international expert consensus regarding the impact of peripheral nerve block (PNB) use in total hip/knee arthroplasty surgery. Methods A systematic review and meta-analysis: randomized controlled and observational studies investigating the impact of PNB utilization on major complications, including mortality, cardiac, pulmonary, gastrointestinal, renal, thromboembolic, neurologic, infectious, and bleeding complications. Medline, PubMed, Embase, and Cochrane Library including Cochrane Database of Systematic Reviews, Cochrane Central Register of Controlled Trials, NHS Economic Evaluation Database, were queried from 1946 to August 4, 2020. The Grading of Recommendations Assessment, Development, and Evaluation approach was used to assess evidence quality and for the development of recommendations. Results Analysis of 122 studies revealed that PNB use (compared with no use) was associated with lower ORs for (OR with 95% CIs) for numerous complications (total hip and knee arthroplasties (THA/TKA), respectively): cognitive dysfunction (OR 0.30, 95% CI 0.17 to 0.53/OR 0.52, 95% CI 0.34 to 0.80), respiratory failure (OR 0.36, 95% CI 0.17 to 0.74/OR 0.37, 95% CI 0.18 to 0.75), cardiac complications (OR 0.84, 95% CI 0.76 to 0.93/OR 0.83, 95% CI 0.79 to 0.86), surgical site infections (OR 0.55 95% CI 0.47 to 0.64/OR 0.86 95% CI 0.80 to 0.91), thromboembolism (OR 0.74, 95% CI 0.58 to 0.96/OR 0.90, 95% CI 0.84 to 0.96) and blood transfusion (OR 0.84, 95% CI 0.83 to 0.86/OR 0.91, 95% CI 0.90 to 0.92). Conclusions Based on the current body of evidence, the consensus group recommends PNB use in THA/TKA for improved outcomes. Recommendation: PNB use is recommended for patients undergoing THA and TKA except when contraindications preclude their use. Furthermore, the alignment of provider skills and practice location resources needs to be ensured. Evidence level: moderate; recommendation: strong.

引用

页码：971 / 985

页数：15

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