Huang Ana Paula Santana, Sakata Rioko Kimiko
Escola Paulista de Medicina, Universidade Federal de São Paulo (Unifesp), São Paulo, SP, Brasil.
Setor de Dor, Universidade Federal de São Paulo (Unifesp), São Paulo, SP, Brasil.
Rev Bras Anestesiol. 2016 Jul-Aug;66(4):395-401. doi: 10.1016/j.bjan.2014.09.003. Epub 2015 Mar 18.
Adequate analgesia after sternotomy reduces postoperative adverse events. There are various methods of treating pain after heart surgery, such as infiltration with a local anesthetic, nerve block, opioids, non-steroidal anti-inflammatory drugs, alpha-adrenergic agents, intrathecal and epidural techniques, and multimodal analgesia.
A review of the epidemiology, pathophysiology, prevention and treatment of pain after sternotomy. We also discuss the various analgesic therapeutic modalities, emphasizing advantages and disadvantages of each technique.
Heart surgery is performed mainly via medium sternotomy, which results in significant postoperative pain and a non-negligible incidence of chronic pain. Effective pain control improves patient satisfaction and clinical outcomes. There is no clearly superior technique. It is believed that a combined multimodal analgesic regimen (using different techniques) is the best approach for treating postoperative pain, maximizing analgesia and reducing side effects.
胸骨切开术后充分镇痛可减少术后不良事件。心脏手术后有多种疼痛治疗方法，如局部麻醉药浸润、神经阻滞、阿片类药物、非甾体抗炎药、α-肾上腺素能药物、鞘内和硬膜外技术以及多模式镇痛。
对胸骨切开术后疼痛的流行病学、病理生理学、预防和治疗进行综述。我们还讨论了各种镇痛治疗方式，重点阐述了每种技术的优缺点。
心脏手术主要通过正中胸骨切开术进行，这会导致明显的术后疼痛以及不可忽视的慢性疼痛发生率。有效的疼痛控制可提高患者满意度和临床结局。没有明显更优的技术。据信，联合多模式镇痛方案（使用不同技术）是治疗术后疼痛的最佳方法，可使镇痛效果最大化并减少副作用。
