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剖宫产术后的最佳疼痛管理

Optimal Pain Management After Cesarean Delivery.

作者信息

Sutton Caitlin Dooley, Carvalho Brendan

机构信息

Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, 300 Pasteur Drive, Stanford, CA 94305, USA.

Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, 300 Pasteur Drive, Stanford, CA 94305, USA.

出版信息

Anesthesiol Clin. 2017 Mar;35(1):107-124. doi: 10.1016/j.anclin.2016.09.010. Epub 2016 Dec 12.

Abstract

Cesarean delivery rates are increasing worldwide, and effective postoperative pain management is a key priority of women undergoing cesarean delivery. Inadequate pain management in the acute postoperative period is associated with persistent pain, greater opioid use, delayed functional recovery, and increased postpartum depression. In addition to pain relief, optimal management of patients after cesarean delivery should address the goals of unrestricted maternal mobility, minimal maternal and neonatal side effects, rapid recovery to baseline functionality, and early discharge home. Multimodal analgesia should include neuraxial morphine in conjunction with nonopioid adjuncts, with additional oral or intravenous opioids reserved for severe breakthrough pain.

摘要

剖宫产率在全球范围内不断上升,有效的术后疼痛管理是接受剖宫产的女性的关键优先事项。术后急性期疼痛管理不足与持续性疼痛、更多阿片类药物使用、功能恢复延迟以及产后抑郁症增加有关。除缓解疼痛外,剖宫产术后患者的最佳管理应实现产妇活动不受限制、产妇和新生儿副作用最小、快速恢复至基线功能以及早日出院回家的目标。多模式镇痛应包括椎管内吗啡联合非阿片类辅助药物,额外的口服或静脉注射阿片类药物留作严重突破性疼痛时使用。

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