Hwang Wonjung
Department of Anesthesiology and Pain Medicine, College of Medicine, The Catholic University of Korea, Seoul St. Mary's Hospital, Seoul, Korea.
Anesth Pain Med (Seoul). 2025 Apr;20(2):109-120. doi: 10.17085/apm.25240. Epub 2025 Apr 30.
Pain management in lung cancer resection has undergone a paradigm shift from opioid-centric approaches to multimodal analgesia, and more recently, personalized strategies that integrate the principles of precision medicine. Historically, opioids have been the mainstay of perioperative analgesia. However, concerns regarding opioid-related adverse effects, including respiratory depression, immunosuppression, and potential oncologic implications, have driven the adoption of opioid-sparing techniques. Current strategies emphasize multimodal analgesia, combining nonsteroidal antiinflammatory drugs, acetaminophen, regional anesthesia, and adjunctive agents to enhance pain control while minimizing opioid exposure. However, growing evidence suggests that perioperative analgesics may differentially influence tumor biology depending on molecular and genetic factors, necessitating a more tailored approach. This has led to the emergence of precision oncoanesthesia, which aims to integrate tumor-specific genomic insights into perioperative pain management. Although promising, the clinical implementation of precision oncoanesthesia remains in its early stages, with key challenges including the lack of large-scale prospective studies, limited real- time genomic profiling in anesthetic planning, and variability in patient responses to analgesics. Future research should focus on identifying biomarkers that predict individual responses to perioperative analgesia and establishing evidence-based guidelines for precision- based pain management. By evolving beyond traditional opioid reliance and standard analgesic protocols, perioperative pain management in lung cancer surgery can align with emerging precision medicine approaches, ensuring effective pain control and optimized oncologic outcomes.
肺癌切除术中的疼痛管理已从以阿片类药物为中心的方法转向多模式镇痛，最近又转向整合精准医学原则的个性化策略。从历史上看，阿片类药物一直是围手术期镇痛的主要手段。然而，对阿片类药物相关不良反应的担忧，包括呼吸抑制、免疫抑制和潜在的肿瘤学影响，促使人们采用减少阿片类药物使用的技术。目前的策略强调多模式镇痛，将非甾体抗炎药、对乙酰氨基酚、区域麻醉和辅助药物联合使用，以增强疼痛控制，同时尽量减少阿片类药物的使用。然而，越来越多的证据表明，围手术期镇痛药可能会根据分子和遗传因素对肿瘤生物学产生不同的影响，因此需要采用更具针对性的方法。这导致了精准肿瘤麻醉的出现，其目的是将肿瘤特异性基因组学见解整合到围手术期疼痛管理中。尽管前景广阔，但精准肿瘤麻醉的临床应用仍处于早期阶段，主要挑战包括缺乏大规模前瞻性研究、麻醉计划中实时基因组分析有限以及患者对镇痛药反应的变异性。未来的研究应专注于识别预测个体对围手术期镇痛反应的生物标志物，并建立基于精准医学的疼痛管理的循证指南。通过超越传统的阿片类药物依赖和标准镇痛方案，肺癌手术中的围手术期疼痛管理可以与新兴的精准医学方法相结合，确保有效的疼痛控制和优化的肿瘤学结果。
