手术后加速康复（ERAS）方案中的疼痛管理
Pain Management in Enhanced Recovery after Surgery (ERAS) Protocols.
作者信息
Simpson J Creswell, Bao Xiaodong, Agarwala Aalok
机构信息
Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Boston, Massachusetts.
出版信息
Clin Colon Rectal Surg. 2019 Mar;32(2):121-128. doi: 10.1055/s-0038-1676477. Epub 2019 Feb 28.
Abstract
Pain control is an integral part of Enhanced Recovery after Surgery (ERAS) protocols for colorectal surgery. While opioid therapy remains the mainstay of therapy for postsurgical pain, opioids have undesired side effects including delayed recovery of bowel function, respiratory depression, and postoperative nausea and vomiting. A variety of nonopioid systemic medical therapies as well as regional and neuraxial techniques have been described as improving pain control while reducing opioid use. Multimodal and preemptive analgesia as part of an ERAS protocol facilitates early mobility and early return of bowel function and decreases postoperative morbidity. In this review, we examine several multimodal therapies and their impact on postoperative analgesia, opioid use, and recovery for patients undergoing colorectal surgery.
摘要
疼痛控制是结直肠手术加速康复外科（ERAS）方案的一个组成部分。虽然阿片类药物治疗仍然是术后疼痛治疗的主要手段，但阿片类药物有不良副作用，包括肠功能恢复延迟、呼吸抑制以及术后恶心和呕吐。多种非阿片类全身药物治疗以及区域和神经轴技术已被描述为在减少阿片类药物使用的同时改善疼痛控制。作为ERAS方案一部分的多模式和超前镇痛有助于早期活动和肠功能早期恢复，并降低术后发病率。在本综述中，我们研究了几种多模式治疗方法及其对接受结直肠手术患者术后镇痛、阿片类药物使用和恢复的影响。
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2
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Colorectal Dis. 2017 Jul;19(7):681-689. doi: 10.1111/codi.13578.
3
Epidural Local Anesthetics Versus Opioid-Based Analgesic Regimens for Postoperative Gastrointestinal Paralysis, Vomiting, and Pain After Abdominal Surgery: A Cochrane Review.硬膜外局部麻醉药与基于阿片类药物的镇痛方案用于腹部手术后胃肠道麻痹、呕吐和疼痛的疗效比较：一项Cochrane系统评价
Anesth Analg. 2016 Dec;123(6):1591-1602. doi: 10.1213/ANE.0000000000001628.
4
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J Arthroplasty. 2017 Apr;32(4):1125-1127. doi: 10.1016/j.arth.2016.10.018. Epub 2016 Oct 21.
5
Transversus abdominal plane block for postoperative analgesia: a systematic review and meta-analysis of randomized-controlled trials.腹横肌平面阻滞用于术后镇痛：一项随机对照试验的系统评价和荟萃分析
Can J Anaesth. 2016 Oct;63(10):1184-1196. doi: 10.1007/s12630-016-0679-x. Epub 2016 Jun 15.
6
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Surg Endosc. 2017 Jan;31(1):127-134. doi: 10.1007/s00464-016-4941-7. Epub 2016 Apr 29.
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Surg Endosc. 2016 Nov;30(11):5117-5125. doi: 10.1007/s00464-016-4862-5. Epub 2016 Mar 22.
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ANZ J Surg. 2015 Dec;85(12):946-50. doi: 10.1111/ans.12475. Epub 2013 Nov 26.
9
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10
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