目的 探讨疼痛专科护士主导的连续收肌管阻滞镇痛管理流程在膝关节置换术后患者中的应用效果。方法 依据共识—行动—反馈—讨论的实施策略制订以疼痛专科护士为主导的连续收肌管阻滞镇痛的管理流程。通过便利抽样法,选取2023年8月—11月在浙江省某三级甲等医院某院区行膝关节置管术后行连续收肌管阻滞镇痛的172例患者为研究对象,比较流程应用前后48 h内镇痛不全发生率和时效指标的差异。结果 护士主导的流程应用后,试验组36 h内活动时镇痛不全发生率、不良反应发生率、患者等待麻醉科处理时间显著低于对照组（P<0.05）。结论 护士主导连续收肌管阻滞镇痛管理流程的应用可明显降低膝关节置管术后镇痛不全的发生率,降低置管后的不良反应发生率,提高医疗效率。
Objective To investigate the effect of continuous adductor canal block analgesia management process led by pain specialist nurses in patients after knee replacement. Methods According to the implementation strategy of consensus-action-feedback-discussion,the management process of continuous adductor canal block for analgesia was developed with pain specialist nurses as the main body. By convenient sampling method,172 patients who underwent continuous adductor canal block for analgesia after knee replacement in a tertiary grade A hospital in Zhejiang Province from August to November 2023 were selected as the study objects,and the differences in the incidence rate of inadequate analgesia and timeliness indicators of analgesia within 48 hours were compared before and after the application of procedure. Results After the application of nurse-led procedure,the incidence of inadequate analgesia,the incidence of adverse reactions and the waiting time for anesthesiology treatment in the experimental group were significantly lower than those in the control group（P<0.05）. Conclusion The application of nurse-led continuous adductor canal block analgesia management process can significantly reduce the incidence of postoperative inadequate analgesia,reduce the incidence of adverse reactions after catheterization,and improve medical efficiency.
[1] Ackerman IN,Bohensky MA,Zomer E,et al.The projected burden of primary total knee and hip replacement for osteoarthritis in Australia to the year 2030[J]. BMC Musculoskelet Disord,2019,20(1):90.
[2] Ghosh A,Chatterji U.An evidence-based review of enhanced recovery after surgery in total knee replacement surgery[J]. J Perioper Pract,2019,29(9):281-290.
[3] Qin L,You D,Zhao G,et al.A comparison of analgesic techniques for total knee arthroplasty:a network meta-analysis[J]. J Clin Anesth,2021,71:110257.
[4] Sun C,Zhang X,Song F,et al.Is continuous catheter adductor canal block better than single-shot canal adductor canal block in primary total knee arthroplasty?:A GRADE analysis of the evidence through a systematic review and meta-analysis[J]. Medicine(Baltimore),2020,99(20):e20320.
[5] Marhofer D,Marhofer P,Triffterer L,et al.Dislocation rates of perineural catheters:a volunteer study[J]. Br J Anaesth,2013,111(5):800-806.
[6] Fredrickson MJ,Leightley P,Wong A,et al.An analysis of 1505 consecutive patients receiving continuous interscalene analgesia at home:a multicentre prospective safety study[J]. Anaesthesia,2016,71(4):373-379.
[7] Walker BJ,Long JB,de Oliveira GS,et al. Peripheral nerve catheters in children:an analysis of safety and practice patterns from the pediatric regional anesthesia network(PRAN)[J]. Br J Anaesth,2015,115(3):457-462.
[8] 张俊峰,蔡莹莹,郑可欣,等. 术后急性疼痛患者自控镇痛管理相关指南的系统评价[J]. 中华护理杂志,2021,56(12):1868-1875.
Zhang JF,Cai YY,Zheng KX,et al.A systematic review of guidelines on the management of patient-controlled analgesia in adult patients with postoperative acute pain[J]. Chin J Nurs,2021,56(12):1868-1875.
[9] 武俐君. 术后自控镇痛泵使用安全管理策略的构建[D]. 湖州:湖州师范学院,2020.
Wu LJ.Construction of safety management strategy for postoperative self-controlled analgesia pump[D]. Huzhou:Huzhou University,2020.
[10] 邢春凤,罗伟香,丁登峰,等. SBAR沟通模式优化病人自控镇痛疼痛管理的研究[J]. 全科护理,2020,18(3):266-269.
Xing CF,Luo WX,Ding DF,et al.Study on SBAR communi-cation mode to optimize patient-controlled analgesia and pain management[J]. Chin Gen Pract Nurs,2020,18(3):266-269.
[11] 刘丽艳,张雅丽. 疼痛专科护士的管理现状与进展[J]. 护理研究,2018,32(21):3358-3360.
Liu LY,Zhang YL.Status quo and progress on management of pain specialist nurses[J]. Chin Nurs Res,2018,32(21):3358-3360.
[12] Chuan A,Lansdown A,Brick KL,et al.Adductor canal versus femoral triangle anatomical locations for continuous catheter analgesia after total knee arthroplasty:a multicentre randomised controlled study[J]. Br J Anaesth,2019,123(3):360-367.
[13] Toyone T,Takahashi K,Kitahara H,et al.Visualisation of symp-tomatic nerve roots. Prospective study of contrast-enhanced MRI in patients with lumbar disc herniation[J]. J Bone Joint Surg Br,1993,75(4):529-533.
[14] 王晓庆,陈毓雯,张园园,等. 骨科快速康复外科建立护士主导的疼痛管理多学科团队的实践[J]. 中国护理管理,2019,19(2):5.
Wang XQ,Chen YW,Zhang YY.Orthopaedic rapid rehabilitation surgery establishes a nurse-led multidisciplinary team practice for pain management[J]. Chin Nurs Manag,2019,19(2):5.
[15] 徐爱华,杭灵燕. 以护士为主导的疼痛管理模式在骨科的开展效果[J]. 中医药管理杂志,2015,23(18):109-110.
Xu AH,Hang LY.Effect of nurse-led pain management model in orthopedics[J]. J Tradit Chin Med Manag,2015,23(18):109-110.
[16] 李会珍,黄莉,林荔军,等. 膝关节置换术后连续股神经阻滞导管规范化管理的效果分析[J]. 解放军护理杂志,2021,38(2):52-54.
Li HZ,Huang L,Lin LJ,et al.Effect of standardized management of continuous femoral nerve block catheter after knee replacement[J]. Nurs J Chin PLA,2021,38(2):52-54.
[17] Faraoni TJ,Kruisselbrink R.Implementation and postoperative management of continuous adductor canal catheters for total knee arthroplasty to reduce surgical backlog related to the COVID-19 pandemic:an acute pain service nursing perspective and educational resource[J]. J Perianesth Nurs,2023,38(2):186-192.
[18] Jabur A,Nam HJ,Dixon A,et al.The effects of continuous catheter adductor canal block for pain management in knee replacement therapy:a meta-analysis[J]. Knee Surg Relat Res,2023,35(1):16.
[19] 彭博. 自控镇痛泵访视在全麻患者腹部手术后疼痛控制中的应用效果[J]. 临床医学研究与实践,2020,5(27):182-184.
Peng B.Application effect of patient controlled analgesia visit on pain control of patients after abdominal surgery under general anesthesia[J]. Clin Res Pract,2020,5(27):182-184.
