University of Pittsburgh School of Medicine, Pittsburgh, PA, USA.
Semin Cardiothorac Vasc Anesth. 2021 Dec;25(4):280-288. doi: 10.1177/1089253221998552. Epub 2021 Apr 25.
Opioid analgesia is still considered the standard of practice for cardiac surgery. In recent years, combinations of several nonnarcotic analgesics and regional analgesia have shown promise in restricting opioid use during and after cardiac surgery. Ketamine infusion, dexmedetomidine infusion, acetaminophen, ketorolac, and gabapentin are useful adjuvants in cardiac anesthesia practice and have opioid-sparing properties. The beneficial effects of nonnarcotic multimodal analgesia on intraoperative stress response, recovery profile, postoperative pain, and persistent opioid use after cardiac surgery are yet to be established, and further randomized clinical trials are required.
阿片类镇痛药仍被认为是心脏手术的标准治疗方法。近年来，几种非麻醉性镇痛药和区域镇痛的联合应用在限制心脏手术后阿片类药物的使用方面显示出了前景。氯胺酮输注、右美托咪定输注、对乙酰氨基酚、酮咯酸和加巴喷丁在心脏麻醉实践中是有用的辅助药物，具有减少阿片类药物使用的特性。非麻醉性多模式镇痛对术中应激反应、恢复情况、术后疼痛和心脏手术后持续使用阿片类药物的有益影响尚未得到证实，还需要进一步的随机临床试验。
