Kurd Mark F, Kreitz Tyler, Schroeder Gregory, Vaccaro Alexander R
From the Department of Orthopaedic Surgery, Thomas Jefferson University Hospital, Philadelphia, PA (Dr. Kreitz), and the Rothman Institute, Philadelphia, PA (Dr. Kurd, Dr. Schroeder, and Dr. Vaccaro).
J Am Acad Orthop Surg. 2017 Apr;25(4):260-268. doi: 10.5435/JAAOS-D-16-00049.
Optimal postoperative pain control allows for faster recovery, reduced complications, and improved patient satisfaction. Historically, pain management after spine surgery relied heavily on opioid medications. Multimodal regimens were developed to reduce opioid consumption and associated adverse effects. Multimodal approaches used in orthopaedic surgery of the lower extremity, especially joint arthroplasty, have been well described and studies have shown reduced opioid consumption, improved pain and function, and decreased length of stay. A growing body of evidence supports multimodal analgesia in spine surgery. Methods include the use of preemptive analgesia, NSAIDs, the neuromodulatory agents gabapentin and pregabalin, acetaminophen, and extended-action local anesthesia. The development of a standard approach to multimodal analgesia in spine surgery requires extensive assessment of the literature. Because a substantial number of spine surgeries are performed annually, a standardized approach to multimodal analgesia may provide considerable benefits, particularly in the context of the increased emphasis on accountability within the healthcare system.
最佳的术后疼痛控制可实现更快的康复、减少并发症并提高患者满意度。从历史上看，脊柱手术后的疼痛管理严重依赖阿片类药物。为减少阿片类药物的使用及相关不良反应，人们制定了多模式镇痛方案。下肢骨科手术，尤其是关节置换术中使用的多模式方法已有详细描述，研究表明这些方法可减少阿片类药物的使用、改善疼痛和功能并缩短住院时间。越来越多的证据支持脊柱手术中的多模式镇痛。方法包括使用超前镇痛、非甾体抗炎药、神经调节药物加巴喷丁和普瑞巴林、对乙酰氨基酚以及长效局部麻醉。制定脊柱手术多模式镇痛的标准方法需要对文献进行广泛评估。由于每年进行大量的脊柱手术，多模式镇痛的标准化方法可能会带来相当大的益处，特别是在医疗系统对问责制日益重视的背景下。
