Department of Anesthesia and Surgical Intensive Care, Hôpital Tenon, APHP, Paris, France -
Department of Anesthesia and Surgical Intensive Care, Hôpital Tenon, APHP, Paris, France.
Minerva Anestesiol. 2023 Nov;89(11):1022-1033. doi: 10.23736/S0375-9393.23.17291-9. Epub 2023 Sep 5.
Accidental or surgically induced thoracic trauma is responsible for significant pain that can impact patient outcomes. One of the main objectives of its pain management is to promote effective coughing and early mobilization to reduce atelectasis and ventilation disorders induced by pulmonary contusion. The incidence of chronic pain can affect more than 35% of patients after both thoracotomy and thoracoscopy as well as after chest trauma. As the severity of acute pain is associated with the incidence of chronic pain, early and effective pain management is very important. In this narrative review, we propose to detail systemic and regional analgesia techniques to minimize postoperative pain, while reducing transitional pain, surgical stress response and opioid side effects. We provide the reader with practical recommendations based on both literature and clinical practice experience in a referral level III thoracic trauma center.
外伤性或手术性胸部创伤会导致严重疼痛，从而影响患者的预后。其疼痛管理的主要目标之一是促进有效咳嗽和早期活动，以减少肺挫伤引起的肺不张和通气障碍。慢性疼痛的发生率可影响超过 35%的开胸和胸腔镜手术后以及胸部创伤后的患者。由于急性疼痛的严重程度与慢性疼痛的发生率相关，因此早期和有效的疼痛管理非常重要。在这篇叙述性综述中，我们建议详细介绍全身和区域镇痛技术，以最大程度地减少术后疼痛，同时减少过渡性疼痛、手术应激反应和阿片类药物的副作用。我们根据三级胸部创伤中心的文献和临床实践经验为读者提供了实用建议。
