Rawal N
Department of Anesthesiology and Intensive Care, Orebro Medical Center Hospital, Sweden.
Eur J Anaesthesiol Suppl. 1995 May;10:47-52.
Good analgesia does not normalize post-operative pulmonary function but is important in allowing measures such as post-operative physiotherapy to be applied following major abdominal or thoracic surgery. Clinical studies have generally failed to duplicate animal work on the effectiveness of pre-emptive analgesia possibly because the nociceptor stimuli persist as long as there is wound pain. Anaesthetic techniques which include sensory blockade are associated with a lower incidence of several post-operative complications and this improvement is more marked in high-risk patients. The contributions of spinal opioids to this is not known. Long-lasting analgesia can be provided via a catheter inserted in a relevant neurovascular compartment. There is no evidence that multimodal 'balanced' analgesia offers any advantages in terms of improved outcome or reduction in adverse events. Whilst sophisticated methods for providing post-operative pain relief, such as PCA and PCEA, are highly effective, they are appropriate for only a minority of surgical operations. An Acute Pain Service can delivery a traditional intermittent opioid regime effectively at relatively low cost.
良好的镇痛效果并不能使术后肺功能恢复正常，但对于在腹部或胸部大手术后进行术后物理治疗等措施而言却很重要。临床研究一般未能重复动物实验中关于超前镇痛有效性的结果，这可能是因为只要存在伤口疼痛，伤害性感受器刺激就会持续存在。包括感觉阻滞在内的麻醉技术与几种术后并发症的发生率较低相关，且这种改善在高危患者中更为明显。脊髓阿片类药物对此的作用尚不清楚。通过插入相关神经血管腔隙的导管可提供持久的镇痛效果。没有证据表明多模式“平衡”镇痛在改善预后或减少不良事件方面具有任何优势。虽然诸如自控镇痛（PCA）和术后持续硬膜外镇痛（PCEA）等复杂的术后疼痛缓解方法非常有效，但它们仅适用于少数外科手术。急性疼痛服务部门可以以相对较低的成本有效地实施传统的间歇性阿片类药物方案。
