Joshi Girish P, Schug Stephan A, Kehlet Henrik
University of Texas Southwestern Medical School, 5323 Harry Hines Blvd, Dallas, TX 75390-9068, USA.
Anaesthesiology Unit, School of Medicine and Pharmacology, University of Western Australia, Perth, Australia.
Best Pract Res Clin Anaesthesiol. 2014 Jun;28(2):191-201. doi: 10.1016/j.bpa.2014.03.005. Epub 2014 May 9.
Optimal dynamic pain relief is a prerequisite for optimizing post-operative recovery and reducing morbidity and convalescence. Procedure-specific pain management initiative aims to overcome the limitations of conventional guidelines and provide health-care professionals with practical recommendations formulated in a way that facilitates clinical decision making across all the stages of the perioperative period. The procedure-specific evidence is supplemented with data from other similar surgical procedures and clinical practices to balance benefits and risks of each analgesic technique. There is emphasis on the use of multimodal analgesia and preventive analgesia aimed at reducing central sensitization. Importantly, the benefits of dynamic pain relief may only be realized if other aspects of perioperative care such as the use of minimally invasive surgery, approaches to reduce stress responses, optimizing fluid therapy and optimizing post-operative nursing care with early mobilization and oral feeding are utilized.
最佳动态疼痛缓解是优化术后恢复、降低发病率和缩短康复期的先决条件。特定手术的疼痛管理倡议旨在克服传统指南的局限性，并为医疗保健专业人员提供切实可行的建议，这些建议的制定方式有助于围手术期各阶段的临床决策。特定手术的证据辅以其他类似外科手术和临床实践的数据，以平衡每种镇痛技术的益处和风险。重点是使用多模式镇痛和预防性镇痛，旨在减少中枢敏化。重要的是，只有在利用围手术期护理的其他方面，如使用微创手术、减轻应激反应的方法、优化液体治疗以及通过早期活动和口服喂养优化术后护理时，才能实现动态疼痛缓解的益处。
