Department of Perioperative Medicine, Intensive Care and Emergency, Cattinara University Hospital, Trieste, Italy.
Department of General and Thoracic Surgery, Cattinara University Hospital, Trieste, Italy.
Eur J Cardiothorac Surg. 2018 May 1;53(5):932-938. doi: 10.1093/ejcts/ezx413.
Video-assisted thoracoscopic surgery is a widespread technique that has been linked to improved postoperative respiratory function, reduced hospital length of stay and a higher level of tolerability for the patients. Acute postoperative pain is of considerable significance, and the late development of neuropathic pain syndrome is also an issue. As anaesthesiologists, we have investigated the available evidence to optimize postoperative pain management. An opioid-sparing multimodal approach is highly recommended. Loco-regional techniques such as the thoracic epidural and peripheral blocks can be performed. Several adjuvants have been employed with varying degrees of success both intravenously and in combination with local anesthetics. Opioids with different pharmacodynamic and pharmacokinetic profiles can be used, either through continuous infusion or on demand. Non-opioid analgesics are also beneficial. Finally, perioperative gabapentinoids may be implemented to prevent the onset of chronic neuropathic pain.
视频辅助胸腔镜手术是一种广泛应用的技术，它与改善术后呼吸功能、缩短住院时间以及提高患者的耐受性有关。急性术后疼痛意义重大，而神经病理性疼痛综合征的迟发性发展也是一个问题。作为麻醉师，我们已经研究了可用的证据来优化术后疼痛管理。强烈推荐使用阿片类药物节约的多模式方法。可以进行局部区域技术，如胸硬膜外和外周阻滞。已经使用了几种佐剂，无论是静脉内还是与局部麻醉剂联合使用，都取得了不同程度的成功。可以使用具有不同药效学和药代动力学特征的阿片类药物，无论是通过持续输注还是按需使用。非阿片类镇痛药也有好处。最后，可以实施围手术期加巴喷丁类药物来预防慢性神经病理性疼痛的发生。
