Department of Anesthesiology, Yale University School of Medicine, New Haven, Connecticut 06511, USA.
Yale J Biol Med. 2010 Mar;83(1):11-25.
Good pain control after surgery is important to prevent negative outcomes such as tachycardia, hypertension, myocardial ischemia, decrease in alveolar ventilation, and poor wound healing. Exacerbations of acute pain can lead to neural sensitization and release of mediators both peripherally and centrally. Clinical wind up occurs from the processes of N-Methyl D-Aspartate (NMDA) activation, wind up central sensitization, long-term potentiation of pain (LTP), and transcription-dependent sensitization. Advances in the knowledge of molecular mechanisms have led to the development of multimodal analgesia and new pharmaceutical products to treat postoperative pain. The new pharmacological products to treat postoperative pain include extended-release epidural morphine and analgesic adjuvants such as capsaicin, ketamine, gabapentin, pregabalin dexmetomidine, and tapentadol. Newer postoperative patient-controlled analgesia (PCA) in modes such as intranasal, regional, transdermal, and pulmonary presents another interesting avenue of development.
术后良好的疼痛控制对于预防心动过速、高血压、心肌缺血、肺泡通气减少和伤口愈合不良等不良后果非常重要。急性疼痛的加剧会导致外周和中枢介质的神经敏化和释放。临床紧张状态来自 N-甲基-D-天冬氨酸（NMDA）的激活、紧张状态中枢敏化、疼痛的长期增强（LTP）和转录依赖性敏化等过程。对分子机制的认识的进步导致了多模式镇痛和治疗术后疼痛的新药的发展。治疗术后疼痛的新型药物包括：硬膜外吗啡持续释放、辣椒素、氯胺酮、加巴喷丁、普瑞巴林、右美托咪定和曲马多等辅助镇痛药。新型术后患者自控镇痛（PCA），如鼻内、区域、透皮和肺内给药等模式，是另一个有趣的发展方向。
