下肢截肢围手术期急性疼痛管理的多模式镇痛方案的制定。
Development of a Multimodal Analgesia Protocol for Perioperative Acute Pain Management for Lower Limb Amputation.
作者信息
De Jong Roberta, Shysh Alexander J
机构信息
Acute Pain Service, Alberta Health Services, Department of Anesthesia, Peter Lougheed Centre, 3500-26 Avenue NE, Calgary, AB, Canada T1Y 6J4.
Cumming School of Medicine, Department of Anesthesia, Peter Lougheed Centre, 3500-26 Avenue NE, Calgary, AB, Canada T1Y 6J4.
出版信息
Pain Res Manag. 2018 Jun 3;2018:5237040. doi: 10.1155/2018/5237040. eCollection 2018.
Abstract
Multimodal analgesia may include pharmacological components such as regional anesthesia, opioid and nonopioid systemic analgesics, nonsteroidal anti-inflammatories, and a variety of adjuvant agents. Multimodal analgesia has been reported for a variety of surgical procedures but not yet for lower limb amputation in vasculopathic patients. Perioperative pain management in these patients presents a particular challenge considering the multiple sources and pathways for acute and chronic pain that are involved, such as chronic ischemic limb pain, postoperative residual limb pain, coexisting musculoskeletal pain, phantom limb sensations, and chronic phantom limb pain. These pain mechanisms are explored and a proposed protocol for multimodal analgesia is outlined taking into account the common patient comorbidities found in this patient population.
摘要
多模式镇痛可能包括药理学成分，如区域麻醉、阿片类和非阿片类全身镇痛药、非甾体抗炎药以及多种辅助药物。多模式镇痛已被报道用于多种外科手术，但尚未用于血管病变患者的下肢截肢手术。考虑到这些患者急性和慢性疼痛涉及的多种来源和途径，如慢性肢体缺血性疼痛、术后残肢疼痛、并存的肌肉骨骼疼痛、幻肢感觉和慢性幻肢疼痛，围手术期疼痛管理面临特殊挑战。本文探讨了这些疼痛机制，并根据该患者群体中常见的患者合并症概述了一种多模式镇痛方案。
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本文引用的文献
1
Postoperative Multimodal Analgesia Pain Management With Nonopioid Analgesics and Techniques: A Review.术后多模式镇痛的非阿片类镇痛药和技术疼痛管理：综述。
JAMA Surg. 2017 Jul 1;152(7):691-697. doi: 10.1001/jamasurg.2017.0898.
2
An update on the pharmacologic management and treatment of neuropathic pain.神经病理性疼痛的药物治疗与管理的最新进展。
JAAPA. 2017 Mar;30(3):13-17. doi: 10.1097/01.JAA.0000512228.23432.f7.
3
Pharmacologic interventions for treating phantom limb pain.治疗幻肢痛的药物干预措施。
Cochrane Database Syst Rev. 2016 Oct 14;10(10):CD006380. doi: 10.1002/14651858.CD006380.pub3.
4
An Algorithm for Neuropathic Pain Management in Older People.老年人神经性疼痛管理算法
Drugs Aging. 2016 Aug;33(8):575-83. doi: 10.1007/s40266-016-0389-7.
5
Intravenous sub-anesthetic ketamine for perioperative analgesia.静脉注射亚麻醉剂量氯胺酮用于围手术期镇痛。
J Anaesthesiol Clin Pharmacol. 2016 Apr-Jun;32(2):160-7. doi: 10.4103/0970-9185.182085.
6
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Anesthesiology. 2016 Mar;124(3):696-705. doi: 10.1097/ALN.0000000000000950.
7
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8
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9
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10
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Best Pract Res Clin Anaesthesiol. 2014 Mar;28(1):59-79. doi: 10.1016/j.bpa.2014.03.001. Epub 2014 Mar 15.
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