From the Department of Plastic and Reconstructive Surgery, Ohio State University.
Division of Hand and Microvascular Surgery, Department of Orthopedic Surgery, Mayo Clinic.
Plast Reconstr Surg. 2024 Apr 1;153(4):838e-849e. doi: 10.1097/PRS.0000000000010694. Epub 2023 May 16.
Fewer than half of all patients undergoing surgery report adequate postoperative pain relief. Poorly managed postoperative pain can lead to complications, increased hospital stays, prolonged rehabilitation, and a decreased quality of life. Pain rating scales are commonly used to identify, manage, and track the perceived intensity of pain. Changes in perceived pain severity and intensity are a key indicator for course of treatment. Postoperative pain is best treated with multimodal management with a variety of analgesic medications and techniques that target different receptors and mechanisms of action in the peripheral and central nervous systems. This includes systemic analgesia, regional analgesia, local analgesia (eg, topical and tumescent analgesia), and nonpharmacologic modalities. It is recommended that this approach is individually tailored and discussed through a shared decision-making approach. This review provides an overview of multimodal management for acute postoperative pain related to plastic surgery procedures. To increase patient satisfaction and provide effective pain control, it is recommended to educate patients on expectations of pain, multimodal options for pain control (including peripheral nerve blocks), complications of unrelieved pain, tracking and monitoring of pain by self-reporting, and how to reduce the use of opioid-based pain medication.
接受手术的患者中，仅有不到一半报告术后疼痛得到充分缓解。术后疼痛管理不佳可能导致并发症、住院时间延长、康复时间延长和生活质量下降。疼痛评分量表常用于识别、管理和跟踪感知到的疼痛强度。疼痛严重程度和强度的变化是治疗过程的关键指标。术后疼痛最好通过多模式管理来治疗，包括各种镇痛药物和技术，这些药物和技术针对外周和中枢神经系统中的不同受体和作用机制。这包括全身镇痛、区域镇痛、局部镇痛（如局部和肿胀镇痛）和非药物治疗方式。建议根据个人情况量身定制，并通过共同决策方法进行讨论。本文综述了与整形手术相关的急性术后疼痛的多模式管理。为了提高患者满意度并提供有效的疼痛控制，建议教育患者了解疼痛的预期、疼痛控制的多模式选择（包括周围神经阻滞）、未缓解疼痛的并发症、自我报告的疼痛跟踪和监测，以及如何减少阿片类药物的使用。
