Department of Pharmacy, Methodist University Hospital, 265 Union Ave, Memphis, TN 38104, USA.
Obstet Gynecol Surv. 2013 Mar;68(3):215-27. doi: 10.1097/OGX.0b013e31827f5119.
Effective postoperative pain management provides improved patient comfort and satisfaction, earlier mobilization, fewer pulmonary and cardiac complications, reduced risk of deep vein thrombosis, faster recovery, and reduced cost of care. Although many therapeutic modalities are available for pain management, the optimal combination in managing postoperative pain in total abdominal hysterectomy is controversial. The objective of this study was to review the literature to formulate optimal, evidence-based preoperative, intraoperative, and postoperative pain management for women undergoing total abdominal hysterectomy. Using the OVID platform, we searched in MEDLINE and PubMed using MeSH terms postoperative pain and total abdominal hysterectomy for published articles from 1960 to the present; we found 545 studies. We screened and included only randomized clinical trials, publications in English, human studies, and abdominal hysterectomy for noncancerous indications. We excluded 456 studies that reported on animal studies; laparoscopic, vaginal, supracervical, or robotic hysterectomy; pharmacokinetic studies; primary outcome other than pain management; and chronic pain management. Studies with inadequate power, poor methodology, or inconclusive results were further excluded from this review. Thus, 89 studies constituted the cohort for our article. Pain control remains complex given variables such as age, anxiety, and extent of surgery. In general, regimens should be tailored to the needs of the individual patient, taking into account medical, psychological, and physical condition. A multimodality approach is better than conventional, single-agent narcotic in achieving optimal pain management. After reading this article, the reader should be able to understand various modalities that can be considered for preoperative, intraoperative, and postoperative pain management in total abdominal hysterectomy.
Obstetricians and gynecologists, family physicians Learning Objectives: After completing this CME activity, physicians should be better able to understand various modalities that can be considered for preoperative, intraoperative, and postoperative pain management in total abdominal hysterectomy.
有效的术后疼痛管理可提高患者舒适度和满意度，促进更早的活动，减少肺部和心脏并发症，降低深静脉血栓形成的风险，更快康复，并降低护理成本。尽管有许多治疗方法可用于疼痛管理，但在全腹部子宫切除术的术后疼痛管理中，最佳联合方案仍存在争议。本研究旨在回顾文献，为行全腹部子宫切除术的女性制定最佳的、基于证据的术前、术中和术后疼痛管理方案。我们使用 OVID 平台，通过使用 MeSH 术语术后疼痛和全腹部子宫切除术在 MEDLINE 和 PubMed 中进行检索，以查找自 1960 年至今发表的文章；共找到 545 项研究。我们仅筛选和纳入了随机临床试验、发表于英语的出版物、人体研究以及非癌症指征的腹部子宫切除术。我们排除了 456 项仅报道动物研究、腹腔镜、阴道、经宫颈或机器人子宫切除术、药代动力学研究、主要结局非疼痛管理以及慢性疼痛管理的研究。我们还进一步排除了那些研究效能低、方法学较差或结果不确定的研究。因此，89 项研究构成了我们文章的队列。鉴于年龄、焦虑和手术范围等变量，疼痛控制仍然很复杂。一般来说，方案应根据患者的个体需求量身定制，考虑到医疗、心理和身体状况。多模式方法优于传统的单一阿片类药物，可实现最佳的疼痛管理。阅读本文后，读者应能够理解可用于全腹部子宫切除术术前、术中和术后疼痛管理的各种方法。
妇产科医生、家庭医生 学习目标：完成这项 CME 活动后，医生应更好地理解可用于全腹部子宫切除术术前、术中和术后疼痛管理的各种方法。
