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辅助镇痛药在急性疼痛中的疗效评估。

Adjuvant Analgesics in Acute Pain - Evaluation of Efficacy.

机构信息

Department of Anesthesiology, Rescue- and Pain Medicine, Cantonal Hospital of St. Gallen, St. Gallen, Switzerland.

Department of Neurosurgery, Cantonal Hospital of Aarau, Aarau, Switzerland.

出版信息

Curr Pain Headache Rep. 2024 Sep;28(9):843-852. doi: 10.1007/s11916-024-01276-w. Epub 2024 Jun 12.


DOI:10.1007/s11916-024-01276-w
PMID:38865074
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC11416428/
Abstract

PURPOSE OF THE REVIEW: Acute postoperative pain impacts a significant number of patients and is associated with various complications, such as a higher occurrence of chronic postsurgical pain as well as increased morbidity and mortality. RECENT FINDINGS: Opioids are often used to manage severe pain, but they come with serious adverse effects, such as sedation, respiratory depression, postoperative nausea and vomiting, and impaired bowel function. Therefore, most enhanced recovery after surgery protocols promote multimodal analgesia, which includes adjuvant analgesics, to provide optimal pain control. In this article, we aim to offer a comprehensive review of the contemporary literature on adjuvant analgesics in the management of acute pain, especially in the perioperative setting. Adjuvant analgesics have proven efficacy in treating postoperative pain and reducing need for opioids. While ketamine is an established option for opioid-dependent patients, magnesium and α2-agonists have, in addition to their analgetic effect, the potential to attenuate hemodynamic responses, which make them especially useful in painful laparoscopic procedures. Furthermore, α2-agonists and dexamethasone can extend the analgesic effect of regional anesthesia techniques. However, findings for lidocaine remain inconclusive.

摘要

目的综述:急性术后疼痛影响了大量患者,并与各种并发症相关,如慢性术后疼痛的发生率更高,发病率和死亡率也更高。

最新发现:阿片类药物常用于治疗严重疼痛,但它们有严重的副作用,如镇静、呼吸抑制、术后恶心和呕吐以及肠道功能受损。因此,大多数术后快速康复方案提倡多模式镇痛,包括辅助镇痛剂,以提供最佳的疼痛控制。本文旨在对辅助镇痛剂治疗急性疼痛的当代文献进行全面综述,尤其是围手术期的急性疼痛。辅助镇痛剂已被证明在治疗术后疼痛和减少阿片类药物需求方面有效。虽然氯胺酮是阿片类药物依赖患者的既定选择,但镁和 α2-激动剂除了具有镇痛作用外,还有减轻血液动力学反应的潜力,这使它们在疼痛性腹腔镜手术中特别有用。此外,α2-激动剂和地塞米松可以延长区域麻醉技术的镇痛效果。然而,利多卡因的研究结果尚不一致。

相似文献

[1]
Adjuvant Analgesics in Acute Pain - Evaluation of Efficacy.

Curr Pain Headache Rep. 2024-9

[2]
Perioperative intravenous ketamine for acute postoperative pain in adults.

Cochrane Database Syst Rev. 2018-12-20

[3]
Opioid-Sparing Analgesia Impacts the Perioperative Anesthetic Management in Major Abdominal Surgery.

Medicina (Kaunas). 2022-3-28

[4]
Multimodal Analgesia, Current Concepts, and Acute Pain Considerations.

Curr Pain Headache Rep. 2017-1

[5]
Efficacy and safety of epidural, continuous perineural infusion and adjuvant analgesics for acute postoperative pain after major limb amputation - a systematic review.

Scand J Pain. 2018-1-26

[6]
Adjuvant analgesics in acute pain.

Expert Opin Pharmacother. 2011-2

[7]
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Curr Opin Support Palliat Care. 2017-6

[8]
Is Multimodal Anesthesia Effecting Postoperative Nausea and Vomiting in Laparoscopic Cholecystectomy?

Pril (Makedon Akad Nauk Umet Odd Med Nauki). 2022-7-13

[9]
Postoperative pain: a review of emerging therapeutic options.

Expert Rev Neurother. 2021-10

[10]
Evolving Role of Local Anesthetics in Managing Postsurgical Analgesia.

Clin Ther. 2015-6-1

引用本文的文献

[1]
Comprehensive Approaches to Pain Management in Postoperative Spinal Surgery Patients: Advanced Strategies and Future Directions.

Neurol Int. 2025-6-18

[2]
Women's Pain Management Across the Lifespan-A Narrative Review of Hormonal, Physiological, and Psychosocial Perspectives.

J Clin Med. 2025-5-14

[3]
Comparison of the Preemptive/Preventive Effect of Dexmedetomidine and Ketorolac on Post-operative Pain of Appendectomy Patients: A Randomized Clinical Trial.

Anesth Pain Med. 2024-12-16

[4]
Advancements in Modern Treatment Approaches for Central Post-Stroke Pain: A Narrative Review.

J Clin Med. 2024-9-11

本文引用的文献

[1]
Cannabinoids for Acute Pain Management: Approaches and Rationale.

Curr Pain Headache Rep. 2024-7

[2]
Nerve Blocks for Craniotomy.

Curr Pain Headache Rep. 2024-5

[3]
Comparing preoperative and postoperative dexamethasone effects on analgesia duration in shoulder surgery.

iScience. 2024-1-24

[4]
The analgesic effectiveness of perioperative lidocaine infusions for acute and chronic persistent postsurgical pain in patients undergoing breast cancer surgery: a systematic review and meta-analysis.

Br J Anaesth. 2024-3

[5]
Effectiveness of the oral Clonidine as a pre-anesthetic medicine for thyroidectomy surgery; A randomized clinical trial.

J Cardiovasc Thorac Res. 2023

[6]
Acute Pain and Development of Opioid Use Disorder: Patient Risk Factors.

Curr Pain Headache Rep. 2023-9

[7]
Meditation as an Adjunct to the Management of Acute Pain.

Curr Pain Headache Rep. 2023-8

[8]
Postoperative acute pain management with duloxetine as compared to placebo: A systematic review with meta-analysis of randomized clinical trials.

Pain Pract. 2023-9

[9]
Efficacy of Preemptive Dexamethasone versus Methylprednisolone in the Management of Postoperative Discomfort and Pain after Mandibular Third Molar Surgery: A Systematic Review and Meta-Analysis.

ScientificWorldJournal. 2023

[10]
Appropriate Duration of Perioperative Intravenous Administration of Lidocaine to Provide Satisfactory Analgesia for Adult Patients Undergoing Colorectal Surgery: A Meta-Analysis of Randomized Controlled Trials.

Anesth Analg. 2023-3-1

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