Patil Jayaditya Devpal, Sefen Jessica Atef Nassef, Fredericks Salim
Royal College of Surgeons in Ireland (RCSI)-Bahrain, Al Muharraq, Bahrain.
Front Surg. 2022 Mar 4;9:801742. doi: 10.3389/fsurg.2022.801742. eCollection 2022.
The management of pain is an essential aspect of surgical care, and pain levels in post-operative patients vary case by case. Treating postoperative pain is crucial as it leads to better outcomes and reduces risk of long term pain. While post-operative analgesics has been the mainstay of treatment, this mini-review explores an emerging concept which is preoperative pain management, with promising potential. Such interventions include educating patients on the expected pain outcomes and available pain medications. Non-pharmacological methods such as relaxation exercises have also proven to be effective after abdominal surgery, and educating patients on the existence of such methods pre-operatively encourages them to make use of available therapies. A major area of importance is the pre-operative psychological and emotional wellbeing of patients, as it is a strong predictor of pain and pain prognosis. Cognitive Behavioral Therapy can be effectively used to tackle preoperative anxiety and reduce pain levels. Hypnosis is another developing modality for decreasing stress. Lastly, long term pre-operative opioid use has been linked with higher pain scores and longer pain duration. This provides the basis on which pre-operative opioid weaning can lead to favorable post-operative pain outcomes. While many of these methods have not been experimented on recipients of abdominal surgery in specific, it still paves the path for newer pain control strategies that can eventually be adopted for visceral surgery patients. This review points the reader and researchers to new and developing areas that hold the potential to revolutionize current established pain management guidelines.
疼痛管理是外科护理的一个重要方面,术后患者的疼痛程度因病例而异。治疗术后疼痛至关重要,因为它能带来更好的结果并降低长期疼痛的风险。虽然术后镇痛药一直是治疗的主要手段,但本综述探讨了一个新兴概念,即术前疼痛管理,其具有广阔的潜力。此类干预措施包括向患者介绍预期的疼痛结果和可用的止痛药物。非药物方法,如放松练习,在腹部手术后也已被证明是有效的,术前向患者介绍此类方法的存在会鼓励他们利用现有的治疗方法。一个重要的主要领域是患者术前的心理和情绪健康,因为它是疼痛和疼痛预后的有力预测指标。认知行为疗法可有效用于应对术前焦虑并降低疼痛程度。催眠是另一种减轻压力的新兴方式。最后,长期术前使用阿片类药物与更高的疼痛评分和更长的疼痛持续时间有关。这为术前阿片类药物戒断可导致良好的术后疼痛结果提供了依据。虽然其中许多方法尚未在腹部手术患者中进行具体试验,但它仍为最终可应用于内脏手术患者的更新疼痛控制策略铺平了道路。本综述向读者和研究人员指出了新的和正在发展的领域,这些领域有可能彻底改变当前既定的疼痛管理指南。