Jain S, Datta S
Department of Anesthesiology and Critical Care Medicine, Memorial Sloan-Kettering Cancer Center, New York, New York, USA.
Chest Surg Clin N Am. 1997 Nov;7(4):773-99.
Postoperative pain management is essential and must be approached as an integral part of the perioperative care. It should be systematic and based on sound physiologic and pharmacologic principles. The intra-operative management of pain is crucial, as there is perhaps an important role for preemptive analgesia. Because of its unique nature, pain is difficult to assess, but for good results adequate and repeated assessment are vital. The literature also points to the detrimental effects of inadequate pain control. There are a variety of methods available for pain management. In choosing a method, various factors need to be considered including physician skill, knowledge of analgesics and routes of administration, patient-related and clinical circumstances, the availability of an environment supportive of effective pain management, and the knowledge and skill of staff to assess and monitor patients. These need to be considered along with the risks and benefits and cost-benefit of the various drugs and techniques. The cornerstone of therapy is opioids, which can be administered by a variety of routes. The use of TEA with opioids and local anesthetics is highly beneficial, especially in high-risk patients. The aim should be to provide all patients a balanced analgesic regimen based on the identification of multiple mechanisms involved in postoperative pain.
术后疼痛管理至关重要，必须作为围手术期护理的一个组成部分来对待。它应该是系统的，并基于合理的生理和药理原则。术中疼痛管理至关重要，因为超前镇痛可能发挥重要作用。由于疼痛的独特性质，其难以评估，但为了取得良好效果，充分且反复的评估至关重要。文献也指出了疼痛控制不足的有害影响。有多种疼痛管理方法可供选择。在选择方法时，需要考虑各种因素，包括医生的技能、对镇痛药及其给药途径的了解、与患者相关的因素和临床情况、是否具备支持有效疼痛管理的环境，以及工作人员评估和监测患者的知识和技能。这些因素需要与各种药物和技术的风险、益处及成本效益一并考虑。治疗的基石是阿片类药物，其可通过多种途径给药。将胸椎旁阻滞与阿片类药物和局部麻醉药联合使用非常有益，尤其是在高危患者中。目标应该是基于对术后疼痛所涉及的多种机制的识别，为所有患者提供一种平衡的镇痛方案。
