Kim Bo Rim, Yoon Soo-Hyuk, Lee Ho-Jin
Department of Anesthesiology and Pain Medicine, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Korea.
Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul, Korea.
Korean J Pain. 2023 Apr 1;36(2):149-162. doi: 10.3344/kjp.23080.
Chronic postsurgical pain (CPSP) is a multifactorial condition that affects a significant proportion of patients undergoing surgery. The prevention and management of CPSP require the identification of preoperative risk factors to screen high-risk patients and establish appropriate perioperative pain management plans to prevent its development. Active postoperative pain management should be provided to prevent CPSP in patients with severe pain following surgery. These tasks have become important for perioperative team members in the management of CPSP. This review article provides a comprehensive overview of the latest research on the role of perioperative team members in preventing and managing CPSP. Additionally, it highlights practical strategies that can be employed in clinical practice, covering the definition and risk factors for CPSP, including preoperative, intraoperative, and postoperative factors, as well as a risk prediction model. The article also explores various treatments for CPSP, as well as preventive measures, including preemptive analgesia, regional anesthesia, pharmacological interventions, psychoeducational support, and surgical technique modification. This article emphasizes the importance of a comprehensive perioperative pain management plan that includes multidisciplinary interventions, using the transitional pain service as an example. By adopting a multidisciplinary and collaborative approach, perioperative team members can improve patient outcomes, enhance patient satisfaction, and reduce healthcare costs. However, further research is necessary to establish targeted interventions to effectively prevent and manage CPSP.
慢性术后疼痛(CPSP)是一种多因素病症,影响着很大比例的接受手术的患者。CPSP的预防和管理需要识别术前风险因素以筛查高危患者,并制定适当的围手术期疼痛管理计划以预防其发生。对于术后剧痛的患者,应进行积极的术后疼痛管理以预防CPSP。这些任务对于围手术期团队成员在CPSP的管理中变得至关重要。这篇综述文章全面概述了围手术期团队成员在预防和管理CPSP方面作用的最新研究。此外,它突出了可在临床实践中采用的实用策略,涵盖CPSP的定义和风险因素,包括术前、术中和术后因素,以及一个风险预测模型。文章还探讨了CPSP的各种治疗方法以及预防措施,包括超前镇痛、区域麻醉、药物干预、心理教育支持和手术技术改进。本文以过渡性疼痛服务为例,强调了包括多学科干预的全面围手术期疼痛管理计划的重要性。通过采用多学科协作方法,围手术期团队成员可以改善患者结局、提高患者满意度并降低医疗成本。然而,需要进一步研究以建立有针对性的干预措施来有效预防和管理CPSP。