Milaković B, Dostanić M, Ivanović S
Department of Anesthesia and Intensive Care, Institute of Neurosurgery, Clinical Center of Serbia, Belgrade.
Acta Chir Iugosl. 2004;51(4):93-100. doi: 10.2298/aci0404093m.
Despite advances in neurosurgical and neuroanesthesiological practice, postoperative pain continues to be undertreated. There are many modalities that may provide safe and effective postoperative analgesia. We discuss mainly systemic (e.g. opioids, nonsteroidal antiinflammatory agents) analgesic options. They still remain the most widely used method for providing pain relief in acute surgical situations. The exact choice or combination of analgesics utilized for a particular patient will depend on the risk benefit profile and patient preferences. Especially is crucial to promptly involve the analgesics when an opioid tolerant patient requires aggressive pain treatment. But, opioid analgesia alone may not fully relieve all aspects of acute postoperative pain. Combinations of drugs acting on different mechanisms of nociceptive modulation will decrease the incidence of adverse effects and offer additive and/or sinergistic effects. Analgesic concentrations of ketamine infusions remain a valuable addition to opioid administration. Complementary medicine techniques used as adjuvant therapies have the potential to improve pain management and improve postoperative distress. Neuromuscular blocking agents (NMB) in the intensive care unit (ICU) patient facilitate intubation and ventilatory support, decrease oxygen consumption, facilitate bedside procedures and diagnostics, and potentially decrease intracranial pressure. Ideally, analgesics, sedatives and/or muscle relaxants should be combined into a multimodal approach to facilitate patient recovery after surgery. Although a great deal is known about specific drugs and dosage requirements, further research is needed that clearly examines optimal scheduling regimens if we are to maximize patient care. The most important rule of pain management is that pain is what the patient says it is.
尽管神经外科和神经麻醉学实践取得了进展，但术后疼痛仍未得到充分治疗。有许多方法可以提供安全有效的术后镇痛。我们主要讨论全身性（如阿片类药物、非甾体抗炎药）镇痛选择。它们仍然是急性手术情况下最广泛使用的缓解疼痛的方法。针对特定患者使用的镇痛药的确切选择或组合将取决于风险效益概况和患者偏好。当阿片类药物耐受的患者需要积极的疼痛治疗时，及时使用镇痛药尤为关键。但是，仅使用阿片类镇痛可能无法完全缓解急性术后疼痛的所有方面。作用于不同伤害性调制机制的药物组合将降低不良反应的发生率，并提供相加和/或协同作用。输注氯胺酮的镇痛浓度仍然是阿片类药物给药的宝贵补充。用作辅助治疗的补充医学技术有可能改善疼痛管理并减轻术后痛苦。重症监护病房（ICU）患者使用神经肌肉阻滞剂（NMB）有助于插管和通气支持，降低氧耗，便于床边操作和诊断，并可能降低颅内压。理想情况下，镇痛药、镇静剂和/或肌肉松弛剂应联合采用多模式方法，以促进患者术后恢复。尽管我们对特定药物和剂量要求了解很多，但如果要最大限度地提高患者护理水平，仍需要进一步研究以明确检查最佳给药方案。疼痛管理最重要的原则是，疼痛就是患者所说的那样。
