Department of Anaesthesia and Pain Management, Royal Melbourne Hospital.
Department of Critical Care, Melbourne Medical School, University of Melbourne, Melbourne, Australia.
Curr Opin Anaesthesiol. 2022 Oct 1;35(5):543-548. doi: 10.1097/ACO.0000000000001168. Epub 2022 Jul 27.
Complex spinal surgery is associated with significant postoperative pain. The purpose of this paper is to review recent literature on postoperative pain management in adult and adolescent patients having complex spinal surgery.
We conducted a literature search using the Medline database for relevant publications from 2020 to 2022 on postoperative pain after complex spinal surgery. Although opioids remain the mainstay to manage pain after complex spinal surgery, they are associated with adverse effects. Multimodal analgesia may be used to reduce these adverse effects by combining different drugs targeting different parts of the pain pathway. Recent publications suggest continuous low dose fentanyl or morphine infusion, methadone, intravenous paracetamol and ibuprofen, ketorolac, ketamine, magnesium infusion, lidocaine infusion and dexmedetomidine appear to be effective and safe to manage pain after complex spinal surgery. Regional techniques including bilateral erector spinae block, interfascial plane block and intrathecal morphine also appear to be effective and safe.
Pain management after complex spinal surgery remains challenging. Therefore, further studies are still required to determine the optimal multimodal analgesic regimen for these patients.
复杂脊柱手术后会出现明显的术后疼痛。本文旨在回顾 2020 年至 2022 年期间有关成人和青少年复杂脊柱手术后患者术后疼痛管理的最新文献。
我们使用 Medline 数据库对 2020 年至 2022 年期间有关复杂脊柱手术后术后疼痛的相关文献进行了检索。尽管阿片类药物仍然是治疗复杂脊柱手术后疼痛的主要药物，但它们会引起不良反应。多模式镇痛可以通过联合作用于疼痛通路不同部位的不同药物来减少这些不良反应。最近的出版物表明，持续低剂量芬太尼或吗啡输注、美沙酮、静脉注射对乙酰氨基酚和布洛芬、酮咯酸、氯胺酮、镁输注、利多卡因输注和右美托咪定似乎可以有效且安全地治疗复杂脊柱手术后的疼痛。区域技术，包括双侧竖脊肌阻滞、筋膜间平面阻滞和鞘内吗啡，也似乎有效且安全。
复杂脊柱手术后的疼痛管理仍然具有挑战性。因此，仍需要进一步的研究来确定这些患者的最佳多模式镇痛方案。
