Department of Anesthesia, Cedars Sinai Medical Center, Los Angeles, California, USA.
Curr Opin Anaesthesiol. 2010 Dec;23(6):697-703. doi: 10.1097/ACO.0b013e32833fad0a.
As outpatient (day-case) surgery had continued to grow throughout the world, many more complex and potentially painful procedures are being routinely performed in the ambulatory setting. Opioid analgesics, once considered the standard approach to preventing acute postoperative pain, are being replaced by a combination of nonopioid analgesic drugs with diverse modes of action as part of a multimodal approach to preventing pain after ambulatory surgery. This review will provide an update on the topic of multimodal pain management for ambulatory (day-case) surgery.
Efficacy of multimodal analgesic regimens continues to improve; opioid analgesics are increasingly taking on the role of 'rescue analgesics' for acute pain after day-case surgery. The use of multimodal analgesia is rapidly becoming the 'standard of care' for preventing pain after ambulatory procedures at most surgery centers throughout the world.
This article discusses recent evidence from the peer-reviewed literature regarding the role of local anesthetics, NSAIDs, gabapentinoids, and acetaminophen, as well as alpha-2 agonists, ketamine, esmolol, and nonpharmacologic approaches (e.g., transcutaneous electrical stimulation) as parts of multimodal pain management strategies in day-case surgery.
随着全球门诊（日间）手术的持续增长，越来越多的复杂且潜在疼痛的手术在日间手术环境中常规开展。阿片类镇痛药曾被认为是预防急性术后疼痛的标准方法，但现在正在被具有不同作用机制的非阿片类镇痛药组合所取代，作为预防日间手术后疼痛的多模式方法的一部分。这篇综述将提供日间手术（日间手术）多模式疼痛管理的最新信息。
多模式镇痛方案的疗效不断提高；阿片类镇痛药在日间手术后急性疼痛中越来越多地扮演“解救镇痛药”的角色。在世界上大多数手术中心，多模式镇痛的使用正在迅速成为预防日间手术疼痛的“标准护理”。
本文讨论了来自同行评议文献的最新证据，涉及局部麻醉剂、非甾体抗炎药、加巴喷丁类药物和对乙酰氨基酚，以及α-2 激动剂、氯胺酮、艾司洛尔和非药物方法（例如经皮电刺激）作为日间手术多模式疼痛管理策略的一部分。
