Kuusniemi Kristiina, Pöyhiä Reino
Department of Anaesthesiology, Turku University, Turku, Finland.
Department of Anaesthesiology, University of Helsinki, Helsinki, Finland; Department of Palliative Medicine and Oncology, University of Turku, Turku, Finland.
J Pain Res. 2016 Feb 3;9:25-36. doi: 10.2147/JPR.S92502. eCollection 2016.
This paper is a summary of presentations on postoperative pain control by the authors at the 2014 PainForum meeting in People's Republic of China. Postoperative pain is often untreated or undertreated and may lead to subsequent chronic pain syndromes. As more procedures migrate to the outpatient setting, postoperative pain control will become increasingly more challenging. Evidence-based guidelines for postoperative pain control recommend pain assessment using validated tools on a consistent basis. In this regard, consistency may be more important than the specific tool selected. Many hospitals have introduced a multidisciplinary acute pain service (APS), which has been associated with improved patient satisfaction and fewer adverse events. Patient education is an important component of postoperative pain control, which may be most effective when clinicians chose a multimodal approach, such as paracetamol (acetaminophen) and opioids. Opioids are a mainstay of postoperative pain control but require careful monitoring and management of side effects, such as nausea, vomiting, dizziness, and somnolence. Opioids may be administered using patient-controlled analgesia systems. Protocols for postoperative pain control can be very helpful to establish benchmarks for pain management and assure that clinicians adhere to evidence-based standards. The future of postoperative pain control around the world will likely involve more and better established APSs and greater communication between patients and clinicians about postoperative pain. The changes necessary to implement and move forward with APSs is not a single step but rather one of continuous improvement and ongoing change.
本文是作者在2014年于中华人民共和国举行的疼痛论坛会议上关于术后疼痛控制的报告总结。术后疼痛常常未得到治疗或治疗不足，可能会导致后续的慢性疼痛综合征。随着越来越多的手术转移到门诊环境，术后疼痛控制将变得越来越具有挑战性。基于证据的术后疼痛控制指南建议持续使用经过验证的工具进行疼痛评估。在这方面，一致性可能比所选择的具体工具更为重要。许多医院已经引入了多学科急性疼痛服务（APS），这与提高患者满意度和减少不良事件相关。患者教育是术后疼痛控制的一个重要组成部分，当临床医生选择多模式方法（如对乙酰氨基酚和阿片类药物）时可能最为有效。阿片类药物是术后疼痛控制的主要手段，但需要仔细监测和管理副作用，如恶心、呕吐、头晕和嗜睡。阿片类药物可使用患者自控镇痛系统给药。术后疼痛控制方案对于确立疼痛管理的基准以及确保临床医生遵循基于证据的标准非常有帮助。全球术后疼痛控制的未来可能会涉及更多且更完善的急性疼痛服务，以及患者与临床医生之间就术后疼痛进行更多的沟通。实施和推进急性疼痛服务所需的改变不是一蹴而就的，而是一个持续改进和不断变化的过程。
