Ramirez Maria F, Kamdar Brinda B, Cata Juan P
Department of Anesthesiology and Perioperative Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
Anesthesiology and Surgical Oncology Research Group, Houston, TX, USA.
Curr Anesthesiol Rep. 2020 Dec;10(4):404-415. doi: 10.1007/s40140-020-00413-6. Epub 2020 Sep 7.
The main purpose of this article is to review recent literature regarding multimodal analgesia medications, citing their recommended doses, efficacy, and side effects. The second part of this report will provide a description of drugs in different stages of development which have novel mechanisms with less side effects such as tolerance and addiction.
Multimodal analgesia is a technique that facilitates perioperative pain management by employing two or more systemic analgesics along with regional anesthesia, when possible. Even though opioids and non-opioid analgesics remain the most common medication used for acute pain management after surgery, they have many undesirable side effects including the potential for misuse. Newer analgesics including peripheral acting opioids, nitric oxide inhibitors, calcitonin gene-related peptide receptor antagonists, interleukin-6 receptor antagonists and gene therapy are under intensive investigation.
A patient's first exposure to opioids is often in the perioperative setting, a vulnerable time when multimodal therapy can play a large role in decreasing opioid exposure. Additionally, the current shift towards faster recovery times, fewer post-operative complications and improved cost-effectiveness during the perioperative period has made multimodal analgesia a central pillar of Enhanced Recovery After Surgery (ERAS) protocols.
本文的主要目的是回顾近期关于多模式镇痛药物的文献，引用其推荐剂量、疗效和副作用。本报告的第二部分将描述处于不同研发阶段的药物，这些药物具有新的作用机制，副作用（如耐受性和成瘾性）较少。
多模式镇痛是一种技术，在可能的情况下，通过使用两种或更多种全身镇痛药以及区域麻醉来促进围手术期疼痛管理。尽管阿片类药物和非阿片类镇痛药仍然是术后急性疼痛管理中最常用的药物，但它们有许多不良副作用，包括误用的可能性。新型镇痛药，包括外周作用阿片类药物、一氧化氮抑制剂、降钙素基因相关肽受体拮抗剂、白细胞介素-6受体拮抗剂和基因治疗，正在深入研究中。
患者首次接触阿片类药物通常是在围手术期，这是一个脆弱时期，多模式治疗在减少阿片类药物暴露方面可以发挥很大作用。此外，目前围手术期朝着更快恢复时间、更少术后并发症和更高成本效益的转变，使得多模式镇痛成为加速康复外科（ERAS）方案的核心支柱。
