Department of Anesthesiology and Pain Management, University of Texas Southwestern Medical Center, Dallas, Texas.
Semin Thorac Cardiovasc Surg. 2013 Summer;25(2):116-24. doi: 10.1053/j.semtcvs.2013.04.002.
Pain after thoracic surgery can be intense and prolonged. Inadequate pain management can have several detrimental effects, including increased postoperative morbidity and delayed recovery as well as occurrence of postthoracotomy syndrome. Therefore, establishing an adequate analgesic regimen for thoracic surgery is critical. Thoracic paravertebral block or thoracic epidural analgesia is recommended as the first-choice therapies for postthoracotomy analgesia. When these techniques are either contraindicated or not possible, intercostal analgesia or intrathecal opioids are recommended. These techniques should be combined with nonopioid analgesics, such as acetaminophen, nonsteroidal anti-inflammatory drugs, or cyclooxygenase-2-specific inhibitors, administered on a regular "round-the-clock" basis, with opioids used as "rescue" analgesics. Finally, the integration of multimodal analgesia techniques with multidisciplinary rehabilitation program can enhance recovery, reduce hospital stay, and facilitate early convalescence.
胸部手术后的疼痛可能很剧烈且持续时间长。疼痛管理不足可能会产生多种不良影响，包括术后发病率增加、恢复延迟以及发生开胸术后综合征。因此，为胸部手术建立适当的镇痛方案至关重要。胸椎旁阻滞或胸椎硬膜外镇痛被推荐为开胸术后镇痛的首选疗法。当这些技术存在禁忌或不可用时，肋间神经阻滞或鞘内阿片类药物被推荐。这些技术应与非阿片类镇痛药联合使用，如对乙酰氨基酚、非甾体抗炎药或环氧化酶-2 特异性抑制剂，以定期“全天”的方式给药，将阿片类药物作为“解救”镇痛药使用。最后，将多模式镇痛技术与多学科康复计划相结合，可以促进恢复、缩短住院时间并促进早期康复。
