Nachiyunde Brenda, Lam Louisa
Department of Health Sciences, School of Nursing and Midwifery, University of South Australia, City East Campus, Adelaide SA 5001, Australia.
School of Nursing and Healthcare Professions, Federation University Australia, Berwick, Victoria, 3806, Australia.
Ann Card Anaesth. 2018 Oct-Dec;21(4):363-370. doi: 10.4103/aca.ACA_186_17.
Cardiac surgery induces severe postoperative pain and impairment of pulmonary function, increases the length of stay (LOS) in hospital, and increases mortality and morbidity; therefore, evaluation of the evidence is needed to assess the comparative benefits of different techniques of pain management, to guide clinical practice, and to identify areas of further research. A systematic search of the Cochrane Central Register of Controlled Trials, DARE database, Joanna Briggs Institute, Google scholar, PUBMED, MEDLINE, EMBASE, Academic OneFile, SCOPUS, and Academic search premier was conducted retrieving 1875 articles. This was for pain management postcardiac surgery in intensive care. Four hundred and seventy-one article titles and 266 abstracts screened, 52 full text articles retrieved for critical appraisal, and ten studies were included including 511 patients. Postoperative pain (patient reported), complications, and LOS in intensive care and the hospital were evaluated. Anesthetic infiltrations and intercostal or parasternal blocks are recommended the immediate postoperative period (4-6 h), and patient-controlled analgesia (PCA) and local subcutaneous anesthetic infusions are recommended immediate postoperative and 24-72 h postcardiac surgery. However, the use of mixed techniques, that is, PCA with opioids and local anesthetic subcutaneous infusions might be the way to go in pain management postcardiac surgery to avoid oversedation and severe nausea and vomiting from the narcotics. Adequate studies in the use of ketamine for pain management postcardiac surgery need to be done and it should be used cautiously.
心脏手术会导致严重的术后疼痛和肺功能受损，增加住院时间，提高死亡率和发病率；因此，需要对证据进行评估，以评估不同疼痛管理技术的相对益处，指导临床实践，并确定进一步研究的领域。我们对Cochrane对照试验中央注册库、DARE数据库、乔安娜·布里格斯研究所、谷歌学术、PUBMED、MEDLINE、EMBASE、Academic OneFile、SCOPUS和学术搜索高级版进行了系统检索，共检索到1875篇文章。这些文章是关于重症监护中心脏手术后的疼痛管理。筛选了471篇文章标题和266篇摘要，检索到52篇全文文章进行严格评估，纳入了10项研究，共511名患者。评估了术后疼痛（患者报告）、并发症以及重症监护病房和医院的住院时间。建议在术后即刻（4 - 6小时）进行麻醉浸润和肋间或胸骨旁阻滞，建议在心脏手术后即刻和术后24 - 72小时使用患者自控镇痛（PCA）和局部皮下麻醉输注。然而，采用混合技术，即PCA联合阿片类药物和局部麻醉皮下输注，可能是心脏手术后疼痛管理的发展方向，以避免因麻醉剂导致过度镇静和严重恶心呕吐。需要对氯胺酮用于心脏手术后疼痛管理进行充分研究，且应谨慎使用。
