Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA 02115, USA.
Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA 02115, USA.
Anesthesiol Clin. 2022 Sep;40(3):455-468. doi: 10.1016/j.anclin.2022.04.002. Epub 2022 Aug 2.
Perioperative pain management is one of the domains in which Anesthesiologists are intricately involved, and which is immensely important. Adequate postoperative analgesia is central to avoid both the acute as well as chronic complications of uncontrolled postoperative pain. Preventive analgesia has been identified as an approach to mitigate the phenomenon of central sensitization, which plays an important role in the development of chronic pain after surgery. As an over-reliance on opioids for peri- and postoperative pain control is associated with opioid dependence and hyperalgesia, multimodal analgesia has taken center stage. Multimodal analgesia, in theory, will optimize perioperative pain control, reduce the chance of central sensitization, and avoid the detrimental effects of opioid overuse. Multiple classes of systemic analgesic medications have been used to accomplish these tasks, and the aim of this article is to outline these medications, their mechanisms of action, as well as the evidence behind their individual roles in multimodal analgesia. Regional anesthesia has also been embraced as a key component of multimodal analgesia in orthopedic surgery; however, over the past several years, local infiltration analgesia (LIA) emerged as a viable alternative, particularly in total knee arthroplasty.
围手术期疼痛管理是麻醉师密切参与的领域之一，也是非常重要的领域。充分的术后镇痛对于避免术后疼痛失控引起的急性和慢性并发症至关重要。预防性镇痛已被确定为减轻中枢敏化现象的一种方法，而中枢敏化在术后慢性疼痛的发展中起着重要作用。由于过度依赖阿片类药物来控制围手术期疼痛与阿片类药物依赖和痛觉过敏有关，因此多模式镇痛已成为焦点。多模式镇痛理论上可以优化围手术期疼痛控制，减少中枢敏化的机会，并避免阿片类药物过度使用的有害影响。已经使用了多类全身镇痛药物来完成这些任务，本文的目的是概述这些药物、它们的作用机制，以及它们在多模式镇痛中的单独作用的证据。区域麻醉也被视为骨科多模式镇痛的关键组成部分；然而，在过去几年中，局部浸润镇痛（LIA）作为一种可行的替代方法出现了，特别是在全膝关节置换术中。
