Department of Anaesthesia and Intensive Care, Government Medical College and Hospital, Sector 32, Chandigarh, 160030, India.
Department of Anesthesiology, Yale University School of Medicine, New Haven, CT, USA.
Curr Pain Headache Rep. 2018 Apr 4;22(5):35. doi: 10.1007/s11916-018-0690-8.
Postoperative pain remains one of the most common challenges following inpatient and outpatient surgeries. With our advances in modern medicine, pain following surgical procedures still remains a challenge, though significant accomplishments have been made over the past few decades. This article highlights some of the promising new advances and approaches in postoperative pain management.
Over the last decade, Enhanced Recovery after Surgery (ERAS) pathways and protocols are becoming the benchmark standards for enhancing postoperative recovery. Multimodal analgesia (MMA) is an essential component of such care. Further, in the wake of serious and persistent concern on the opioid epidemic in the USA, there has been a recent renewal of interest in non-opioid alternatives or adjuncts in controlling postoperative pain, often in the context of MMA. Intravenous (IV) acetaminophen, non-steroidal anti-inflammatory drugs (NSAIDs), magnesium, ketamine, dexmedetomidine, liposomal bupivacaine, and newer neuraxial and peripheral regional techniques as well as patient-controlled modalities are gaining importance. Gabapentinoids have become popular but recent meta-analytic reviews have cast doubt on their routine use in perioperative settings. Among opioids, sublingual sufentanil, IV oxycodone, and iontophoretic transdermal fentanyl hold promise. Acupuncture and transcutaneous electrical nerve stimulation may be useful as adjuncts in MMA packages. Genetic testing, derivatives of herbal preparations, and an extended role of acute pain services may emerge as potential areas of importance in the future. There are, however, critical gaps in good quality evidence in many of the practice guideline recommendations. In the era of opioid epidemic, several lines of evidence have emerged to support non-opioid-based drugs and approaches along with a few newer opioid formulations for postoperative pain management, although more research is needed to find the right balance of efficacy and safety.
术后疼痛仍然是住院和门诊手术后最常见的挑战之一。尽管在过去几十年中取得了重大进展，但随着现代医学的进步，手术后的疼痛仍然是一个挑战。本文重点介绍了术后疼痛管理方面的一些有前途的新进展和方法。
在过去的十年中，术后加速康复（ERAS）途径和方案正在成为增强术后恢复的基准标准。多模式镇痛（MMA）是这种护理的重要组成部分。此外，在美国对阿片类药物流行的严重和持续关注之后，人们对控制术后疼痛的非阿片类替代药物或辅助药物重新产生了兴趣，通常是在 MMA 的背景下。静脉内（IV）对乙酰氨基酚、非甾体抗炎药（NSAIDs）、镁、氯胺酮、右美托咪定、脂质体布比卡因以及新的脊神经和外周区域技术以及患者自控模式都变得越来越重要。加巴喷丁类药物已变得流行，但最近的荟萃分析评论对其在围手术期常规使用提出了质疑。在阿片类药物中，舌下芬太尼、IV 羟考酮和经皮电刺激透皮芬太尼有希望成为 MMA 方案的有效药物。针刺和经皮电神经刺激可能作为 MMA 方案的辅助手段有用。基因检测、草药制剂的衍生物以及急性疼痛服务的扩展作用可能成为未来重要的潜在领域。然而，许多实践指南建议中的高质量证据存在重大差距。在阿片类药物流行的时代，出现了一些证据支持非阿片类药物为基础的药物和方法，以及一些新的阿片类药物制剂用于术后疼痛管理，尽管需要更多的研究来找到疗效和安全性的适当平衡。
