Ladjević Nebojša, Milinić Maja, Jovanović Vesna, Jovičić Jelena, Likić Ivana, Ladjević Nikola
Faculty of Medicine, University of Belgrade, Belgrade, Serbia.
Center for Anesthesiology and Reanimatology, University Clinical Centre of Serbia, Belgrade, Serbia.
Acta Clin Croat. 2023 Nov;62(Suppl4):88-96. doi: 10.20471/acc.2023.62.s4.13.
Chronic postoperative pain (CPOP) is a serious health issue that affects millions of patients every year. The incidence of CPOP is the highest after amputations, inguinal hernioplasty, thoracotomies, cardiac surgery and breast surgery. In addition to surgical factors, the other risk factors are: female gender, younger age, preoperative pain, psychological state and acute postoperative pain. The most common expression of CPOP is neuropathic pain after surgical trauma. The treatment of chronic postoperative neuropathic pain (CPNP) is difficult. Various methods have been recommended for its prevention, the most important being techniques that avoid nerve damage and adequate perioperative analgesia. The goal of this review was to discuss data from published studies examining the incidence, risk factors and mechanisms of CPOP, with a focus on surgery, the unique opportunity to implement pharmacological strategies for prevention of CPNP and current pharmacotherapy approaches for treatment of CPNP. Commonly used drugs to prevent and treat CPNP in the current clinical setting are: opioids, α2-adrenergic agonists, cyclooxygenase antagonists, gabapentin, pregabalin, steroids, N-methyl-D-aspartate receptor antagonists and local anesthetics.
慢性术后疼痛（CPOP）是一个严重的健康问题，每年影响数百万患者。CPOP的发生率在截肢、腹股沟疝修补术、开胸手术、心脏手术和乳腺手术后最高。除手术因素外，其他风险因素包括：女性、年轻、术前疼痛、心理状态和术后急性疼痛。CPOP最常见的表现是手术创伤后的神经性疼痛。慢性术后神经性疼痛（CPNP）的治疗很困难。已经推荐了各种预防方法，其中最重要的是避免神经损伤的技术和充分的围手术期镇痛。本综述的目的是讨论已发表研究中关于CPOP的发生率、风险因素和机制的数据，重点是手术、实施预防CPNP的药理学策略的独特机会以及目前治疗CPNP的药物治疗方法。目前临床环境中预防和治疗CPNP常用的药物有：阿片类药物、α2肾上腺素能激动剂、环氧化酶拮抗剂、加巴喷丁、普瑞巴林、类固醇、N-甲基-D-天冬氨酸受体拮抗剂和局部麻醉剂。
