Gupta Ruchir, Van de Ven Thomas, Pyati Srinivas
Department of Anesthesiology, Mayo Clinic Hospital, Phoenix, AZ, 85054, USA.
Department of Anesthesiology, Duke University School of Medicine, Durham Veterans Affairs Health Systems, 508 Fulton St, Durham, NC, 27705, USA.
Drugs. 2020 Nov;80(16):1677-1684. doi: 10.1007/s40265-020-01390-0.
Treating acute pain after thoracotomy surgery and preventing the development of chronic post-thoracotomy pain syndrome (PTPS) remain significant challenges in this surgical population. While appropriately treated acute thoracotomy pain often resolves, a significant number of patients develop PTPS, with up to 65% of patients experiencing some pain and 10% suffering life-altering, debilitating pain. Currently, there is very little known about specific molecular targets or novel therapeutic combinations that effectively prevent PTPS. Identifying modifiable clinical risk factors (procedure, physical and mental health, preoperative pain in the surgical area and another regions) seems to the most pragmatic approach for prevention for now. Effective acute pain management adopting a multimodal approach can result in a decreased incidence of PTPS. Interventional techniques such as paraverterbral blocks, intercostal blocks, and erector spinae blocks show some promise as well. Future research should be focused on minimally invasive surgeries and also the effect of ERAS protocols, including early mobilization, nutrition, and early removal of drains, on the development of PTPS.
在接受开胸手术的患者群体中，治疗开胸术后急性疼痛并预防慢性开胸术后疼痛综合征（PTPS）的发生仍然是重大挑战。虽然经适当治疗的急性开胸术后疼痛通常会缓解，但仍有相当数量的患者会发展为PTPS，高达65%的患者会经历某种程度的疼痛，10%的患者遭受改变生活、使人衰弱的疼痛。目前，对于有效预防PTPS的特定分子靶点或新型治疗组合知之甚少。目前，识别可改变的临床风险因素（手术、身心健康、手术区域及其他区域的术前疼痛）似乎是最务实的预防方法。采用多模式方法进行有效的急性疼痛管理可降低PTPS的发生率。椎旁阻滞、肋间阻滞和竖脊肌阻滞等介入技术也显示出一定前景。未来的研究应聚焦于微创手术以及加速康复外科（ERAS）方案（包括早期活动、营养支持和早期拔除引流管）对PTPS发生的影响。
