Pergolizzi Joseph V, LeQuang Jo Ann, Magnusson Peter, Varrassi Giustino
NEMA Research, Inc, Naples, Florida, USA.
School of Medical Sciences, Faculty of Medicine and Health, Örebro University, Örebro, Sweden.
Expert Rev Neurother. 2023 Jul-Dec;23(12):1297-1310. doi: 10.1080/14737175.2023.2284872. Epub 2023 Dec 15.
Chronic postsurgical pain (CPSP) is a prevalent condition that can diminish health-related quality of life, cause functional deficits, and lead to patient distress. Rates of CPSP are higher for certain types of surgeries than others (thoracic, breast, or lower extremity amputations) but can occur after even uncomplicated minimally invasive procedures. CPSP has multiple mechanisms, but always starts as acute postsurgical pain, which involves inflammatory processes and may encompass direct or indirect neural injury. Risk factors for CPSP are largely known but many, such as female sex, younger age, or type of surgery, are not modifiable. The best strategy against CPSP is to quickly and effectively treat acute postoperative pain using a multimodal analgesic regimen that is safe, effective, and spares opioids.
This is a narrative review of the literature.
Every surgical patient is at some risk for CPSP. Control of acute postoperative pain appears to be the most effective approach, but principles of good opioid stewardship should apply. The role of regional anesthetics as analgesics is gaining interest and may be appropriate for certain patients. Finally, patients should be better informed about their relative risk for CPSP.
慢性术后疼痛（CPSP）是一种常见病症，会降低与健康相关的生活质量，导致功能缺陷，并使患者痛苦。某些类型的手术（如胸部、乳腺或下肢截肢手术）的CPSP发生率高于其他手术，但即使是简单的微创手术后也可能发生。CPSP有多种机制，但总是始于急性术后疼痛，急性术后疼痛涉及炎症过程，可能包括直接或间接的神经损伤。CPSP的风险因素大多已知，但许多因素，如女性、年轻或手术类型，是无法改变的。预防CPSP的最佳策略是使用安全、有效且避免使用阿片类药物的多模式镇痛方案快速有效地治疗急性术后疼痛。
这是一篇文献综述。
每位手术患者都有发生CPSP的风险。控制急性术后疼痛似乎是最有效的方法，但应遵循良好的阿片类药物管理原则。区域麻醉作为镇痛方法的作用正受到关注，可能适用于某些患者。最后，应让患者更好地了解其发生CPSP的相对风险。
