胸外科手术后强化康复计划中的疼痛管理
Pain management within an enhanced recovery program after thoracic surgery.
作者信息
Thompson Calvin, French Daniel G, Costache Ioana
机构信息
Department of Anesthesiology and Pain Medicine, University of Ottawa, Ottawa, Ontario, Canada.
Division Thoracic Surgery, Department of Surgery, Dalhousie University, Halifax, Nova Scotia, Canada.
出版信息
J Thorac Dis. 2018 Nov;10(Suppl 32):S3773-S3780. doi: 10.21037/jtd.2018.09.112.
Abstract
Evidence for ERAS within thoracic surgery (ERATS) is building. The key to enabling early recovery and ambulation is ensuring that postoperative pain is well controlled. Surgery on the chest is considered to be one of the most painful of surgical procedures for both open and minimally invasive surgery (MIS) approaches. Increasing use of MIS and improved perioperative care pathways has resulted in shorter length of stay (LOS), requiring patients to achieve optimal pain control earlier and meet discharge criteria sooner, sometimes on the same day as surgery. This requires optimizing pain control earlier in the postoperative recovery phase in order to enable ambulation and a better recovery profile, as well as to minimize the risk for development of chronic persistent postoperative pain (CPPP). This review will focus on the options for pain management protocols within an ERAS program for thoracic surgery patients (ERATS).
摘要
胸外科加速康复（ERATS）的证据正在不断积累。实现早期康复和下床活动的关键在于确保术后疼痛得到良好控制。无论是开放手术还是微创手术（MIS），胸部手术都被认为是最疼痛的外科手术之一。MIS的使用增加以及围手术期护理路径的改善，导致住院时间（LOS）缩短，要求患者更早实现最佳疼痛控制并更快达到出院标准，有时甚至在手术当天。这就需要在术后恢复阶段更早地优化疼痛控制，以实现下床活动和更好的恢复情况，同时将慢性持续性术后疼痛（CPPP）的发生风险降至最低。本综述将聚焦于胸外科手术患者加速康复计划（ERATS）中疼痛管理方案的选择。
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