Montero Matamala Antonio, Hanna Magdi, Perrot Serge, Varrassi Giustino
Department of Surgery, University of Lleida, Lleida, ESP.
Department of Anesthesiology, University of London, London, GBR.
Cureus. 2022 Feb 15;14(2):e22243. doi: 10.7759/cureus.22243. eCollection 2022 Feb.
Acute postoperative pain is a normal and expected part of the patient's postsurgical trajectory, and its intensity, severity, and duration vary with surgery-related and patient factors. In a subset of patients, postoperative pain does not resolve as the tissue heals but instead transitions to chronic postoperative pain, a challenging condition to treat and one associated with decreased quality of life, sleep and mood disorders, and neuropathy. Promptly and adequately treating acute postoperative pain can reduce the risk that it will transition into chronic postoperative pain. Numerous agents are available that may help treat postoperative pain, including nonsteroidal anti-inflammatory drugs, opioids, antidepressants, anticonvulsants, and others. In this connection, it is also important to consider patient factors, such as mental health status and comorbidities, as well as the type and duration of surgery. A multimodal approach is recommended, which uses two or more agents with complementary mechanisms of action, working at different targets. Multimodal analgesia may also reduce adverse events and lessen opioid consumption after surgery. A particularly useful fixed-dose combination product is dexketoprofen/tramadol (DEX-TRA), which is safe and effective in numerous clinical trials. This review is based on a presentation from the Roma Pain Days scientific sessions of 2021.
急性术后疼痛是患者术后病程中正常且预期会出现的一部分，其强度、严重程度和持续时间会因手术相关因素和患者因素而有所不同。在一部分患者中，术后疼痛不会随着组织愈合而缓解，而是会转变为慢性术后疼痛，这是一种难以治疗的病症，与生活质量下降、睡眠和情绪障碍以及神经病变有关。及时、充分地治疗急性术后疼痛可以降低其转变为慢性术后疼痛的风险。有多种药物可用于治疗术后疼痛，包括非甾体抗炎药、阿片类药物、抗抑郁药、抗惊厥药等。在这方面，考虑患者因素，如心理健康状况和合并症，以及手术类型和持续时间也很重要。建议采用多模式方法，即使用两种或更多种具有互补作用机制、作用于不同靶点的药物。多模式镇痛还可以减少不良事件并减少术后阿片类药物的使用量。一种特别有用的固定剂量复方产品是右酮洛芬/曲马多（DEX-TRA），它在众多临床试验中都是安全有效的。本综述基于2021年罗马疼痛日科学会议上的一次报告。
