Garimella Veerabhadram, Cellini Christina
Division of Colorectal Surgery, Department of Surgery, University of Rochester Medical Center, Rochester, New York.
Clin Colon Rectal Surg. 2013 Sep;26(3):191-6. doi: 10.1055/s-0033-1351138.
The effective relief of pain is of the utmost importance to anyone treating patients undergoing surgery. Pain relief has significant physiological benefits; hence, monitoring of pain relief is increasingly becoming an important postoperative quality measure. The goal for postoperative pain management is to reduce or eliminate pain and discomfort with a minimum of side effects. Various agents (opioid vs. nonopioid), routes (oral, intravenous, neuraxial, regional) and modes (patient controlled vs. "as needed") for the treatment of postoperative pain exist. Although traditionally the mainstay of postoperative analgesia is opioid based, increasingly more evidence exists to support a multimodal approach with the intent to reduce opioid side effects (such as nausea and ileus) and improve pain scores. Enhanced recovery protocols to reduce length of stay in colorectal surgery are becoming more prevalent and include multimodal opioid sparing regimens as a critical component. Familiarity with the efficacy of available agents and routes of administration is important to tailor the postoperative regimen to the needs of the individual patient.
对于任何治疗接受手术患者的人来说,有效缓解疼痛至关重要。疼痛缓解具有显著的生理益处;因此,对疼痛缓解的监测正日益成为一项重要的术后质量指标。术后疼痛管理的目标是将疼痛和不适减轻或消除,同时使副作用最小化。治疗术后疼痛有多种药物(阿片类与非阿片类)、途径(口服、静脉、神经轴、区域)和模式(患者自控与“按需”)。虽然传统上术后镇痛的主要手段是以阿片类药物为基础,但越来越多的证据支持采用多模式方法,以减少阿片类药物的副作用(如恶心和肠梗阻)并改善疼痛评分。减少结直肠手术住院时间的强化康复方案正变得越来越普遍,其中包括多模式阿片类药物节省方案作为关键组成部分。熟悉现有药物的疗效和给药途径对于根据个体患者的需求调整术后治疗方案很重要。