Niculae Andrei, Checherita Ionel Alexandru, Peride Ileana, Tiglis Mirela, Ene Razvan, Neagu Tiberiu Paul, Ene Dragos
Clinical Department No. 3, "Carol Davila" University of Medicine and Pharmacy, 020021 Bucharest, Romania.
Department of Nephrology, County Emergency Hospital Ilfov, 022104 Bucharest, Romania.
J Clin Med. 2024 Dec 16;13(24):7646. doi: 10.3390/jcm13247646.
Controlling pain after major orthopedic surgery may be challenging, and it is related to delayed recovery, the development of chronic pain, and analgesic dependence. It is well known that effective postoperative pain control can reduce hospital stays by ensuring a more rapid rehabilitation,thereby decreasing the overall costs. Despite the development of analgesics, the use of opioids and their derivates remains the cornerstone of treatment for patients with acute moderate-to-severe pain in association with general or regional anesthesia. To reduce the risk of side effects and opioid addiction, considering the alarming epidemiological reports in relation to opioid abuse, combined analgesic methods are used, in addition to lower dosages or different forms of administration, such as transdermal administration. Fentanyl transdermal patches appear to be effective in controlling postoperative pain as part of multimodal analgesic regimens in knee and hip surgery, shoulder arthroplasty, traumatic fractures, and one-day surgery; this treatment has fewer associated side effects and can be safely used even in patients with renal impairment. It is also recommended for postoperative pain management in combination with a femoral-sciatic nerve block during foot and ankle surgery.
大型骨科手术后的疼痛控制可能具有挑战性，且与恢复延迟、慢性疼痛的发展以及镇痛药物依赖有关。众所周知，有效的术后疼痛控制可通过确保更快康复来缩短住院时间，从而降低总体费用。尽管镇痛药有所发展，但在全身麻醉或区域麻醉相关的急性中重度疼痛患者中，阿片类药物及其衍生物的使用仍是治疗的基石。考虑到有关阿片类药物滥用的惊人流行病学报告，为降低副作用和阿片类药物成瘾的风险，除了降低剂量或采用不同给药形式（如透皮给药）外，还会使用联合镇痛方法。芬太尼透皮贴剂作为多模式镇痛方案的一部分，在膝关节和髋关节手术、肩关节置换术、创伤性骨折以及日间手术中似乎对控制术后疼痛有效；这种治疗的相关副作用较少，即使是肾功能不全患者也可安全使用。在足踝手术期间，它还被推荐与股-坐骨神经阻滞联合用于术后疼痛管理。
