Department of Anesthesiology, Rescue- and Pain Medicine, Cantonal Hospital of St. Gallen, St. Gallen, Switzerland.
Department of Neurosurgery, Cantonal Hospital of Aarau, Aarau, Switzerland.
Curr Pain Headache Rep. 2024 Sep;28(9):843-852. doi: 10.1007/s11916-024-01276-w. Epub 2024 Jun 12.
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.
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.
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。
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。
