Anesthesiology and Pain Management, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX, 75390-9068, USA.
Curr Pain Headache Rep. 2023 Aug;27(8):227-237. doi: 10.1007/s11916-023-01137-y. Epub 2023 Jul 5.
A multimodal analgesic approach improves postoperative pain relief and reduces opioid use; however, it is not universally implemented. This review presents the evidence assessing multimodal analgesic regimens and recommends optimal analgesic combinations.
The evidence for best combinations of individual patients undergoing specific procedures is lacking. Nevertheless, an optimal multimodal regimen may be determined based on identifying efficacious, safe, and inexpensive analgesics interventions. Key components of an optimal multimodal analgesic regimen include the preoperative identification of patients at high risk for postoperative pain in addition to patient and caregiver education. Unless contraindicated, all patients should receive a combination of acetaminophen, non-steroidal anti-inflammatory drug or cycoxygenase-2-specific inhibitor, dexamethasone, and procedure-specific regional analgesic technique and/or surgical site local anesthetic infiltration. Opioids should be administered as rescue adjuncts. Non-pharmacological interventions are important components of an optimal multimodal analgesic technique. It is imperative to integrate multimodal analgesia regimens within a multidisciplinary enhanced recovery pathway.
多模式镇痛方法可改善术后疼痛缓解并减少阿片类药物的使用；然而，它并未被普遍实施。本综述介绍了评估多模式镇痛方案的证据，并推荐了最佳的镇痛联合用药。
对于接受特定手术的个体患者，最佳联合用药的证据尚缺乏。然而，基于识别有效、安全和廉价的镇痛干预措施，可能确定最佳的多模式治疗方案。最佳多模式镇痛方案的关键组成部分包括术前识别术后疼痛风险高的患者，以及患者和护理人员的教育。除非有禁忌证，否则所有患者均应接受以下药物的联合治疗：对乙酰氨基酚、非甾体抗炎药或环氧化酶-2 特异性抑制剂、地塞米松，以及针对特定手术的区域镇痛技术和/或手术部位局部麻醉浸润。阿片类药物应作为辅助急救药物。非药物干预是最佳多模式镇痛技术的重要组成部分。必须将多模式镇痛方案整合到多学科强化康复途径中。
