From the Department of Anesthesiology, University of Cincinnati Medical Center, Cincinnati, Ohio.
Department of Anesthesia and Perioperative Medicine, Medical University of South Carolina, Charleston, South Carolina.
Anesth Analg. 2023 Jul 1;137(1):2-25. doi: 10.1213/ANE.0000000000006441. Epub 2023 Apr 20.
Pain after thoracic surgery is of moderate-to-severe intensity and can cause increased postoperative distress and affect functional recovery. Opioids have been central agents in treating pain after thoracic surgery for decades. The use of multimodal analgesic strategies can promote effective postoperative pain control and help mitigate opioid exposure, thus preventing the risk of developing persistent postoperative pain. This practice advisory is part of a series developed by the Society of Cardiovascular Anesthesiologists (SCA) Quality, Safety, and Leadership (QSL) Committee's Opioid Working Group. It is a systematic review of existing literature for various interventions related to the preoperative and intraoperative pain management of thoracic surgical patients and provides recommendations for providers caring for patients undergoing thoracic surgery. This entails developing customized pain management strategies for patients, which include preoperative patient evaluation, pain management, and opioid use-focused education as well as perioperative use of multimodal analgesics and regional techniques for various thoracic surgical procedures. The literature related to this field is emerging and will hopefully provide more information on ways to improve clinically relevant patient outcomes and promote recovery in the future.
胸外科手术后的疼痛属于中重度，可引起术后不适增加，并影响功能恢复。几十年来，阿片类药物一直是治疗胸外科手术后疼痛的主要药物。采用多模式镇痛策略有助于实现有效的术后疼痛控制，减少阿片类药物暴露，从而预防持续性术后疼痛的发生风险。本实践指南是心血管麻醉医师学会（SCA）质量、安全和领导力（QSL）委员会阿片类药物工作组制定的一系列指南之一，对与胸外科患者术前和术中疼痛管理相关的各种干预措施进行了系统评价，并为胸外科患者的护理人员提供了相关建议。这需要为患者制定定制化的疼痛管理策略，包括术前患者评估、疼痛管理、以及以阿片类药物使用为重点的教育，同时在围手术期使用多模式镇痛和各种胸外科手术的区域技术。该领域的相关文献正在不断涌现，有望为未来提供更多改善临床相关患者结局和促进康复的方法。
