在全髋关节置换术和全膝关节置换术的围手术期管理中，加速康复外科路径常会纳入多模式镇痛药物，以减少阿片类药物使用、促进术后恢复。加巴喷丁类药物曾被广泛用于这类路径中，但其镇痛获益和安全性一直存在争议，尤其是在术后低血压、镇静、头晕等不良反应方面。

因此，一个值得麻醉医生关注的问题是：在全髋关节或全膝关节置换术患者中，常规使用加巴喷丁类药物是否真的必要？如果从骨科加速康复路径中取消这类药物，是否会影响术后低血压发生率和围手术期用药安全？

下面这篇文献将回答这个问题。

文献英文标题

Impact of Eliminating Gabapentinoids From an Orthopedic Enhanced Recovery Protocol on Postoperative Hypotension After Total Joint Arthroplasty.

英文摘要要点

Methods:

This initiative was conducted at a tertiary academic medical center as part of ongoing medication safety monitoring within an established ERAS program. Routine perioperative gabapentinoids were removed from the orthopedic ERAS pathway following multidisciplinary review, education, and correction of an electronic order set autoselection defect. Outcomes were monitored using routinely collected clinical data from adult patients undergoing primary or revision total hip or knee arthroplasty. The primary outcome was postoperative hypotension occurring from postoperative day 1 to discharge. Gabapentinoid exposure rates and patient and procedural characteristics were tracked to contextualize changes over time.

Results:

A total of 1246 total joint arthroplasty cases were included during the quality monitoring period. Following pathway modification, gabapentinoid exposure decreased from 532 of 589 cases (90.3%) to 102 of 543 cases (18.8%) (P < .0001). This change was accompanied by a descriptive decrease in postoperative hypotension from 59 of 589 cases (10.0%) to 36 of 543 cases (6.6%). Patient demographics, procedure types, and anesthesia distributions remained similar across monitoring periods, suggesting that observed changes were temporally associated with pathway modification rather than shifts in case mix.

Conclusions:

Eliminating routine gabapentinoids from a total joint arthroplasty ERAS pathway was associated with lower observed rates of postoperative hypotension and substantially lower gabapentinoid exposure. This quality improvement initiative demonstrates how multidisciplinary review, electronic order set evaluation, and structured monitoring can support safer medication use and improve the reliability of perioperative care pathways.

文献标题中文翻译

从骨科加速康复方案中取消加巴喷丁类药物对全关节置换术后低血压的影响

文献简介

加速康复外科（enhanced recovery after surgery，ERAS）路径强调通过标准化、循证化的围手术期管理促进患者恢复，其中多模式镇痛是重要组成部分。加巴喷丁类药物曾被纳入多种骨科 ERAS 路径，用于减少术后疼痛和阿片类药物需求。然而，随着临床证据积累，其常规使用的获益并不一致，相关安全性问题也逐渐受到关注。

在全髋关节置换术和全膝关节置换术患者中，术后低血压可能影响早期活动、康复进程和总体围手术期安全。对于已经建立的 ERAS 路径，某些药物可能因为路径惯性、医嘱集默认勾选或历史习惯而持续使用，即使其风险获益比已经需要重新评估。

本研究围绕骨科 ERAS 路径中的常规加巴喷丁类药物使用展开，重点观察在多学科审查、医嘱集修正和持续质量监测后，取消常规加巴喷丁类药物是否与术后低血压发生率变化相关。该研究的核心意义不只在于评价一种药物，也在于提示围手术期路径应被持续审查和动态优化。