Reuben Scott S, Buvanendran Asokumar
Department of Anesthesiology, Baystate Medical Center, 759 Chestnut Street, Springfield, MA 01199, USA.
J Bone Joint Surg Am. 2007 Jun;89(6):1343-58. doi: 10.2106/JBJS.F.00906.
The prevalences of complex regional pain syndrome, phantom limb pain, chronic donor-site pain, and persistent pain following total joint arthroplasty are alarmingly high. Central nervous system plasticity that occurs in response to tissue injury may contribute to the development of persistent postoperative pain. Many researchers have focused on methods to prevent central neuroplastic changes from occurring through the utilization of preemptive or preventive multimodal analgesic techniques. Multimodal analgesia allows a reduction in the doses of individual drugs for postoperative pain and thus a lower prevalence of opioid-related adverse events. The rationale for this strategy is the achievement of sufficient analgesia due to the additive effects of, or the synergistic effects between, different analgesics. Effective multimodal analgesic techniques include the use of nonsteroidal anti-inflammatory drugs, local anesthetics, alpha-2 agonists, ketamine, alpha(2)-delta ligands, and opioids.
复杂区域疼痛综合征、幻肢痛、慢性供区疼痛以及全关节置换术后持续性疼痛的患病率高得惊人。因组织损伤而发生的中枢神经系统可塑性可能促使术后持续性疼痛的发展。许多研究人员专注于通过采用超前或预防性多模式镇痛技术来防止中枢神经可塑性变化的发生。多模式镇痛可减少术后疼痛单一药物的剂量，从而降低阿片类药物相关不良事件的发生率。该策略的基本原理是不同镇痛药的相加作用或协同作用可实现充分镇痛。有效的多模式镇痛技术包括使用非甾体抗炎药、局部麻醉药、α-2激动剂、氯胺酮、α（2）-δ配体和阿片类药物。
