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慢性疼痛干预在多模式围手术期疼痛管理中的作用不断扩大:叙述性综述。

The expanding role of chronic pain interventions in multimodal perioperative pain management: a narrative review.

机构信息

Anesthesiology and Perioperative Care Service, Veterans Affairs Palo Alto Health Care System; Palo Alto, California, USA.

Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine; Stanford, California, USA.

出版信息

Postgrad Med. 2022 Jun;134(5):449-457. doi: 10.1080/00325481.2021.1935281. Epub 2021 Jun 8.

Abstract

Surgery is a risk factor for chronic pain and long-term opioid use. As perioperative pain management continues to evolve, treatment modalities traditionally used for chronic pain therapy may provide additional benefit to patients undergoing surgery. Interventions such as radiofrequency ablation, cryoneurolysis, and neuromodulation may potentially be used in conjunction with acute pain procedures such as nerve blocks and multimodal analgesia. Pharmacological agents associated with chronic pain medicine, including gabapentinoids, ketamine, and selective serotonin reuptake inhibitors, may be useful adjuncts in perioperative pain management when indicated. There may also be a role for acupuncture, music therapy, and other integrative medicine therapies. A transitional pain service can help coordinate outpatient care with inpatient perioperative pain management and promote a more personalized and comprehensive approach that can improve postoperative outcomes.

摘要

手术是慢性疼痛和长期使用阿片类药物的一个风险因素。随着围手术期疼痛管理的不断发展,传统上用于慢性疼痛治疗的治疗方式可能会为接受手术的患者带来额外的益处。射频消融、冷冻神经松解和神经调节等干预措施可能与神经阻滞和多模式镇痛等急性疼痛程序联合使用。与慢性疼痛药物相关的药理学制剂,包括加巴喷丁类药物、氯胺酮和选择性 5-羟色胺再摄取抑制剂,在围手术期疼痛管理中,如果有指征,可能是有用的辅助手段。针灸、音乐疗法和其他整合医学疗法也可能有作用。过渡性疼痛服务可以帮助协调门诊和住院围手术期疼痛管理,并促进更个性化和全面的方法,从而改善术后结果。

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