Lu Jun, Ji Wentao, Sang Chao, Wang Zhi, Bo Lulong
Department of Anesthesiology, Changhai Hospital, Naval Medical University, Shanghai, 200433, People's Republic of China.
Department of Anesthesiology, Yueyang Hospital of Integrated Traditional and Western Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, 200437, People's Republic of China.
J Pain Res. 2025 May 31;18:2761-2773. doi: 10.2147/JPR.S511019. eCollection 2025.
Peroral Endoscopic Myotomy (POEM) is a minimally invasive procedure for treating esophageal achalasia, but effective postoperative pain management remains a challenge. Pain following POEM is multifactorial, arising from mechanical, chemical, and thermal stimuli that activate nociceptive and neuropathic pain pathways. A multimodal analgesia approach, combining opioids, non-opioid analgesics, and regional anesthesia, is currently the most effective strategy. Opioids remain a cornerstone of pain management, but their side effects, such as nausea and constipation, highlight the need for alternatives. Non-opioid analgesics, including acetaminophen, COX-2 inhibitors, and magnesium, have shown promise in reducing pain and opioid use. Regional anesthesia techniques, such as thoracic paravertebral blocks and erector spinae plane blocks, have been explored, though their efficacy in POEM remains inconclusive. Despite advances, there are ongoing challenges in standardizing pain management protocols. Variability in clinical practices and limited high-quality research with small sample sizes complicate the development of universally applicable guidelines. Additionally, while current research primarily focuses on acute postoperative pain, long-term outcomes, such as chronic pain and quality of life, require further investigation. Addressing these gaps in knowledge will be key to improving pain management practices and optimizing recovery for POEM patients. Future studies should focus on refining multimodal analgesia strategies, exploring new analgesic agents, and evaluating long-term pain management outcomes to enhance patient care and improve clinical results.
经口内镜下肌切开术（POEM）是一种治疗食管贲门失弛缓症的微创手术，但术后有效的疼痛管理仍然是一个挑战。POEM术后疼痛是多因素的，源于激活伤害性和神经性疼痛通路的机械、化学和热刺激。目前，将阿片类药物、非阿片类镇痛药和区域麻醉相结合的多模式镇痛方法是最有效的策略。阿片类药物仍然是疼痛管理的基石，但其副作用，如恶心和便秘，凸显了寻找替代药物的必要性。包括对乙酰氨基酚、COX-2抑制剂和镁在内的非阿片类镇痛药在减轻疼痛和减少阿片类药物使用方面已显示出前景。尽管已经探索了区域麻醉技术，如胸椎旁神经阻滞和竖脊肌平面阻滞，但其在POEM中的疗效仍不明确。尽管取得了进展，但在标准化疼痛管理方案方面仍存在挑战。临床实践的差异以及样本量小的高质量研究有限，使得制定普遍适用的指南变得复杂。此外，虽然目前的研究主要集中在术后急性疼痛，但慢性疼痛和生活质量等长期结果需要进一步研究。填补这些知识空白将是改善疼痛管理实践和优化POEM患者康复的关键。未来的研究应专注于完善多模式镇痛策略、探索新的镇痛药物以及评估长期疼痛管理结果，以加强患者护理并改善临床效果。
