Department of Anesthesiology, Veterans Affairs Hospital, Miami, Florida, USA
Department of Anesthesiology, University of Miami, Miami, Florida, USA.
Reg Anesth Pain Med. 2019 Jan;44(1):13-28. doi: 10.1136/rapm-2018-000001.
Cancer causes considerable suffering and 80% of advanced cancer patients experience moderate to severe pain. Surgical tumor excision remains a cornerstone of primary cancer treatment, but is also recognized as one of the greatest risk factors for metastatic spread. The perioperative period, characterized by the surgical stress response, pharmacologic-induced angiogenesis, and immunomodulation results in a physiologic environment that supports tumor spread and distant reimplantation.In the perioperative period, anesthesiologists may have a brief and uniquewindow of opportunity to modulate the unwanted consequences of the stressresponse on the immune system and minimize residual disease. This reviewdiscusses the current research on analgesic therapies and their impact ondisease progression, followed by an evidence-based evaluation of perioperativepain interventions and medications.
癌症会导致相当大的痛苦，80%的晚期癌症患者会经历中到重度疼痛。手术切除肿瘤仍然是原发性癌症治疗的基石，但也被认为是转移扩散的最大风险因素之一。围手术期以手术应激反应、药物诱导的血管生成和免疫调节为特征，导致支持肿瘤扩散和远处再植入的生理环境。在围手术期，麻醉师可能有一个短暂而独特的机会来调节应激反应对免疫系统的不良影响，并最大限度地减少残留疾病。这篇综述讨论了目前关于镇痛疗法及其对疾病进展影响的研究，随后对围手术期疼痛干预和药物进行了基于证据的评估。
