Department of Anesthesiology and Critical Care Medicine, INSERM UMR 1051, Montpellier University Hospital, University of Montpellier, Montpellier, France.
Curr Opin Crit Care. 2017 Oct;23(5):430-439. doi: 10.1097/MCC.0000000000000440.
The aim is to demonstrate that ICU physicians should play a pivotal role in developing regional anesthesia techniques that are underused in critically ill patients despite the proven facts in perioperative and long-term pain, organ dysfunction, and postsurgery patient health-related quality of life improvement.
Regional anesthesia and/or analgesia strategies in ICU reduce the surgical and trauma-stress response in surgical patients as well as complications incidence. Recent studies suggested that surgical/trauma ICU patients receive opioid-hypnotics continuous infusions to prevent pain and agitation that could increase the risk of posttraumatic stress disorder and chronic neuropathic pain symptoms, and chronic opioid use. Regional anesthesia use decrease the use of intravenous opioids and the ectopic activity of injured small fibers limiting those phenomena. In Cochrane reviews and prospective randomized trials in major surgery patients, regional anesthesia accelerates the return of the gastrointestinal transit and rehabilitation, decreases postoperative pain and opioids use, reduces ICU/hospital stay, improves pulmonary outcomes, including long period of mechanical ventilation and early extubation, reduces overall adverse cardiac events, and reduces ICU admissions when compared with general anesthesia and intravenous opiates alone. The reduction of long-term mortality has been reported in major vascular or orthopedic surgeries.
Promoting regional anesthesia/analgesia in ICU surgical/trauma patients could undoubtedly limit the risk of complications, ICU/hospital stay, and improve patient's outcome. The use of regional anesthesia permits a high doses opioid use limitation which is mandatory and should be considered as feasible and well tolerated in ICU.
目的在于表明 ICU 医师应该在区域麻醉技术的发展中发挥关键作用，尽管围手术期和长期疼痛、器官功能障碍以及术后患者健康相关生活质量改善方面已有确凿的事实，但这些技术在危重症患者中并未得到充分应用。
在外科患者中，ICU 中的区域麻醉和/或镇痛策略可减轻手术和创伤应激反应以及并发症的发生率。最近的研究表明，外科/创伤 ICU 患者接受阿片类药物-催眠药物持续输注，以预防疼痛和躁动，这可能会增加创伤后应激障碍和慢性神经病理性疼痛症状以及慢性阿片类药物使用的风险。区域麻醉的使用减少了静脉内阿片类药物的使用和损伤的小纤维的异位活动，从而限制了这些现象。在主要手术患者的 Cochrane 综述和前瞻性随机试验中，区域麻醉可加速胃肠道转运和康复，减轻术后疼痛和阿片类药物的使用，减少 ICU/住院时间，改善肺部结局，包括长时间机械通气和早期拔管，减少整体不良心脏事件，并降低与全身麻醉和单独静脉阿片类药物相比的 ICU 入院率。在大血管或骨科手术中已报告降低了长期死亡率。
在 ICU 外科/创伤患者中推广区域麻醉/镇痛无疑可以降低并发症、ICU/住院时间和改善患者预后的风险。区域麻醉的使用允许限制阿片类药物的高剂量使用，这是强制性的，并且在 ICU 中应被认为是可行且可耐受的。
