Suksompong Sirilak, von Bormann Suparpit, von Bormann Benno
Department of Anesthesiology, Siriraj Hospital, Bangkok, Thailand.
Institute of Nursing, Suranaree University of Technology, Korat, Thailand.
Anesth Pain Med. 2020 Feb 19;10(1):e99745. doi: 10.5812/aapm.99745. eCollection 2020 Feb.
Perioperative analgesia is an essential but frequently underrated component of medical care. The purpose of this work is to describe the actual situation of surgical patients focusing on effective pain control by discarding prejudice against 'aggressive' measures.
This is a narrative review about continuous regional pain therapy with catheters in the postoperative period. Included are the most-relevant literature as well as own experiences.
As evidenced by an abundance of studies, continuous regional/neuraxial blocks are the most effective approach for relief of severe postoperative pain. Catheters have to be placed in adequate anatomical positions and meticulously maintained as long as they remain in situ. Peripheral catheters in interscalene, femoral, and sciatic positions are effective in patients with surgery of upper and lower limbs. Epidural catheters are effective in abdominal and thoracic surgery, birth pain, and artery occlusive disease, whereas paravertebral analgesia may be beneficial in patients with unilateral approach of the truncus. However, failure rates are high, especially for epidural catheter analgesia. Unfortunately, many reports lack a comprehensive description of catheter application, management, failure rates and complications and thus cannot be compared with each other.
Effective control of postoperative pain is possible by the application of regional/neuraxial catheters, measures requiring dedication, skill, effort, and funds. Standard operating procedures contribute to minimizing complications and adverse side effects. Nevertheless, these methods are still not widely accepted by therapists, although more than 50% of postoperative patients suffer from 'moderate, severe or worst' pain.
围手术期镇痛是医疗护理中必不可少但常被低估的组成部分。这项工作的目的是通过摒弃对“激进”措施的偏见，描述手术患者在有效疼痛控制方面的实际情况。
这是一篇关于术后使用导管进行持续区域疼痛治疗的叙述性综述。纳入了最相关的文献以及自身经验。
大量研究表明，持续区域/神经轴阻滞是缓解术后重度疼痛的最有效方法。导管必须放置在合适的解剖位置，并在其留置期间精心维护。在斜角肌、股部和坐骨位置的外周导管对上肢和下肢手术患者有效。硬膜外导管在腹部和胸部手术、分娩疼痛及动脉闭塞性疾病中有效，而椎旁镇痛对采用单侧入路的躯干手术患者可能有益。然而，失败率很高，尤其是硬膜外导管镇痛。不幸的是，许多报告缺乏对导管应用、管理、失败率和并发症的全面描述，因此无法相互比较。
通过应用区域/神经轴导管可以有效控制术后疼痛，这些措施需要投入精力、技巧、努力和资金。标准操作程序有助于将并发症和不良副作用降至最低。尽管超过50%的术后患者遭受“中度、重度或极重度”疼痛，但这些方法仍未被治疗师广泛接受。
