Segura-Méndez B, Guerrero-Peral A L, Carrascal Y
Hospital Clínico Universitario de Valladolid, Valladolid, España.
Universidad de Valladolid, Valladolid, España.
Rev Neurol. 2022 Sep 16;75(6):149-157. doi: 10.33588/rn.7506.2022194.
Despite the evolution of surgical techniques, pain continues to be one of the most frequent disorders in the postoperative period of cardiac surgery (CS), leading to the appearance of complications in the acute period and impairment of quality of life due to the appearance of chronic pain. In this narrative review, we aim to analyze the prognostic factors for the appearance of postoperative pain after CS, to locate and quantify the severity of neuropathic pain, and determine the most appropriate assessment methods in these patients.
Postoperative pain in CS is a complex pain, which associates neuropathic, somatic and visceral components. Its origin is multifactorial; factors depending on the patient, the preoperative symptoms and the type of intervention, as well as sequelae derived from the surgery itself, determine the variability in its manifestation. Multiple studies have tried to identify the risk factors for its development, but the quantification of pain is limited by the subjective perception of the patients.
Neurologists can play a relevant role in the differentiation of the different types of pain after CS, thanks to the understanding of its neurobiological bases, properly handling neuromodulators that control the neuropathic component of pain and collaborating in the indication of invasive techniques, necessary occasionally in the management of these patients.
尽管外科技术不断发展，但疼痛仍是心脏手术（CS）术后最常见的病症之一，导致急性期出现并发症，并因慢性疼痛的出现而损害生活质量。在这篇叙述性综述中，我们旨在分析CS术后疼痛出现的预后因素，定位并量化神经性疼痛的严重程度，并确定这些患者最合适的评估方法。
CS术后疼痛是一种复杂的疼痛，它伴有神经性、躯体性和内脏性成分。其起源是多因素的；取决于患者的因素、术前症状和干预类型，以及手术本身产生的后遗症，决定了其表现的变异性。多项研究试图确定其发生的危险因素，但疼痛的量化受到患者主观感受的限制。
由于对CS术后不同类型疼痛的神经生物学基础有深入了解，能够正确使用控制疼痛神经性成分的神经调节剂，并在必要时协作进行侵入性技术的应用，神经科医生在区分CS术后不同类型疼痛方面可发挥重要作用。
