Almási Róbert Gyula
Klinikai Központ, Janus Pannonius Klinikai Tömb, Aneszteziológiai és Intenzív Terápiás Intézet, Fájdalomterápiás Tanszék, Pécsi Tudományegyetem, Általános Orvostudományi Kar Pécs, Ifjúság u. 13., 7624.
Orv Hetil. 2019 Apr;160(15):573-584. doi: 10.1556/650.2019.31374.
The perioperative pain management - instead of the efforts, guidelines and protocols - is underestimated and undertreated. Even in the case of general anaesthesia, the nervous system is overwhelmed by copious quantities of nociceptive stimuli at surgical incision. Stress and pain-modulation processes are triggered which can have significant influence on the outcome. Often the pain-management is discontinued, so a notable part of patients complain about pain in the ward after surgery. Regional anaesthesia conceptually prevents noxious inputs to enter the central nervous system, beyond surgical anaesthesia it is pertinent to achieve excellent analgesia in the immediate postoperative period as well. Based on current literature, this paper provides an overview of the history and role of regional anaesthesia in the multidimensional model of pain. Besides the sensitization caused by nociceptive stimuli - peripheral and central sensitization, descending modulation - there are several biopsychosocial factors involved in pain pathophysiology. Preventing the side effects of general anaesthesia, the ultrasound-guided peripheral nerve blockade is a safe technique with high success rate, rare side effects, achieving long-lasting, excellent analgesia. Continuous perineural catheter placed under ultrasound provides extended pain control. As a part of multimodal analgesia, peripheral nerve blockade prevents central sensitization. After surgery, the pain intensity of patients under peripheral nerve blockade is less, the chronification tendency is decreased, the quality of life and patients' comfort are improved, and the stress-response is attenuated. The greater part of patients are protected from the undesirable side effects of general anaesthesia. Nowadays, it is an unequivocal evidence that the increasingly used peripheral nerve blockades prior to incision are efficient tools in the prevention of chronic postoperative pain. Ultrasound guidance is suitable not only for surgical anaesthesia, but for postoperative pain management as well, however, besides economic factors, the main goal of this technique is to match the best interest of the patients. Orv Hetil. 2019; 160(15): 573-584.
围手术期疼痛管理——而非努力、指南和方案——被低估且治疗不足。即使在全身麻醉的情况下，手术切口处大量的伤害性刺激也会使神经系统不堪重负。应激和疼痛调节过程被触发，这可能对结果产生重大影响。疼痛管理常常中断，因此相当一部分患者术后在病房抱怨疼痛。区域麻醉从概念上可防止有害输入进入中枢神经系统，除了手术麻醉外，在术后即刻实现良好的镇痛也很重要。基于当前文献，本文概述了区域麻醉在多维疼痛模型中的历史和作用。除了伤害性刺激引起的敏化——外周和中枢敏化、下行调制——疼痛病理生理学还涉及几个生物心理社会因素。超声引导下的外周神经阻滞可预防全身麻醉的副作用，是一种成功率高、副作用少、能实现持久良好镇痛的安全技术。超声引导下放置的连续神经周围导管可提供延长的疼痛控制。作为多模式镇痛的一部分，外周神经阻滞可防止中枢敏化。术后，接受外周神经阻滞的患者疼痛强度较小，慢性化倾向降低，生活质量和患者舒适度提高，应激反应减弱。大部分患者可免受全身麻醉的不良副作用影响。如今，有明确证据表明，术前越来越多地使用外周神经阻滞是预防慢性术后疼痛的有效工具。超声引导不仅适用于手术麻醉，也适用于术后疼痛管理，然而，除经济因素外，该技术的主要目标是符合患者的最大利益。《匈牙利医学周报》。2019年；160(15):573 - 584。
