Copenhagen University, Centre of Head and Orthopaedics, Department of Anaesthesia, Denmark.
Expert Opin Pharmacother. 2010 Oct;11(15):2459-70. doi: 10.1517/14656566.2010.499124.
Recently, much attention has been directed towards the effect of opioid-sparing strategies on postoperative morbidity and hospitalization, and on different nociceptive mechanisms involved in various postoperative pain states and surgical procedures. This has resulted in an increased interest in secondary, or adjunct, analgesics and procedure-specific analgesic methods.
The present paper aims to review and discuss recent developments within the field of various adjunct, systemic analgesics and local/regional anesthetic methods for management of postoperative pain, based on evidence from randomized, clinical trials published within the last 5 years.
The reader will gain insight into the current role of pregabalin, glucocorticoids and systemic lidocaine for the management of postoperative pain. In addition, the current status of local infiltration analgesia for hip and knee arthroplasty, transversus abdominis plane block for abdominal operations, and the analgesic effect of wound instillation of capsaicin are reviewed.
The evidence of a substantial analgesic effect of pregabalin on acute postoperative pain is questionable, and more convincing evidence of the role of glucocorticoids and systemic lidocaine is needed before they should be recommended as analgesics in daily clinical practice. Local infiltration analgesia after hip and knee arthroplasty, transversus abdominis plane block after abdominal operations and local application of capsaicin lend some promise, but there is still a lack of well-performed RCTs to draw any firm conclusions. Procedure-specific analgesic combinations within well-defined rehabilitation paradigms should be explored further to reduce adverse effects associated with the use of conventional analgesic treatment protocols, and to improve postoperative outcome.
最近，人们越来越关注阿片类药物节约策略对术后发病率和住院率的影响，以及不同术后疼痛状态和手术过程中涉及的不同伤害性机制。这导致人们对继发性或辅助性镇痛药和特定于手术的镇痛方法产生了更大的兴趣。
本文旨在根据过去 5 年内发表的随机临床试验的证据，综述和讨论各种辅助性全身性镇痛药和局部/区域麻醉方法在管理术后疼痛方面的最新进展。
读者将深入了解普瑞巴林、糖皮质激素和全身利多卡因在术后疼痛管理中的当前作用。此外，还回顾了髋关节和膝关节置换术后局部浸润镇痛、腹部手术中腹横肌平面阻滞以及辣椒素伤口灌洗的镇痛效果的现状。
普瑞巴林对急性术后疼痛有明显镇痛作用的证据值得怀疑，在推荐糖皮质激素和全身利多卡因作为日常临床实践中的镇痛药之前，还需要更有说服力的证据。髋关节和膝关节置换术后局部浸润镇痛、腹部手术后腹横肌平面阻滞和局部应用辣椒素有一定的希望，但仍缺乏良好的随机对照试验来得出任何明确的结论。应进一步探索特定于手术的镇痛组合，以降低与常规镇痛治疗方案相关的不良反应，并改善术后结果。
