Shay Joanne E, Kattail Deepa, Morad Athir, Yaster Myron
Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University, Baltimore, MD, USA.
Paediatr Anaesth. 2014 Jul;24(7):724-33. doi: 10.1111/pan.12444.
Pain following intracranial surgery has historically been undertreated because of the concern that opioids, the analgesics most commonly used to treat moderate-to-severe pain, will interfere with the neurologic examination and adversely affect postoperative outcome. Over the past decade, accumulating evidence, primarily in adult patients, has revealed that moderate-to-severe pain is common in neurosurgical patients following surgery. Using the neurophysiology of pain as a blueprint, we have highlighted some of the drugs and drug families used in multimodal pain management. This analgesic method minimizes opioid-induced adverse side effects by maximizing pain control with smaller doses of opioids supplemented with neural blockade and nonopioid analgesics, such nonsteroidal antiinflammatory drugs, local anesthetics, corticosteroids, N-methyl-D-aspartate (NMDA) antagonists, α2 -adrenergic agonists, and/or anticonvulsants (gabapentin and pregabalin).
由于担心阿片类药物（最常用于治疗中重度疼痛的镇痛药）会干扰神经学检查并对术后结果产生不利影响，颅内手术后的疼痛在历史上一直未得到充分治疗。在过去十年中，主要在成年患者中积累的证据表明，神经外科手术后患者中中重度疼痛很常见。以疼痛的神经生理学为蓝图，我们重点介绍了多模式疼痛管理中使用的一些药物和药物类别。这种镇痛方法通过使用较小剂量的阿片类药物并辅以神经阻滞和非阿片类镇痛药（如非甾体抗炎药、局部麻醉药、皮质类固醇、N-甲基-D-天冬氨酸 (NMDA) 拮抗剂、α2-肾上腺素能激动剂和/或抗惊厥药（加巴喷丁和普瑞巴林））来最大限度地控制疼痛，从而将阿片类药物引起的不良副作用降至最低。
