Muller L, Viel E, Veyrat E, Eledjam J J
Département d'anesthésie-réanimation, centre hospitalier universitaire, Nîmes, France.
Ann Fr Anesth Reanim. 1998;17(6):599-612. doi: 10.1016/s0750-7658(98)80043-9.
Regional analgesia is a very effective way to treat postoperative pain. Lumbar and thoracic epidural analgesia are well adapted to major abdominal and thoracic surgery. Nevertheless, respiratory side effects induced by opioids are potentially severe and an adequate monitoring is essential. In orthopaedic surgery, perineural blocks are the best technique to manage postoperative pain and perineural catheters may be used. The importance of intra-articular analgesia, simple and safe, is not fully understood. The association of a local anaesthetic inducing a minor motor block and a strong sensitive block (bupivacaine, ropivacaine), with an opioid seems to be the best pharmacologic choice regarding quality of analgesia and safety. Benefits of postoperative regional analgesia on mortality and morbidity are not demonstrated. Medical and nursing staff and specialized units should improve quality of postoperative regional analgesia as well. General guidelines for the practice of regional anaesthesia must be closely followed.
区域镇痛是治疗术后疼痛的一种非常有效的方法。腰段和胸段硬膜外镇痛非常适用于腹部和胸部的大手术。然而，阿片类药物引起的呼吸副作用可能很严重，充分的监测至关重要。在骨科手术中，神经周围阻滞是管理术后疼痛的最佳技术，也可使用神经周围导管。关节内镇痛简单且安全，但其重要性尚未得到充分认识。将诱导轻微运动阻滞和强烈感觉阻滞的局部麻醉药（布比卡因、罗哌卡因）与阿片类药物联合使用，在镇痛质量和安全性方面似乎是最佳的药理学选择。术后区域镇痛对死亡率和发病率的益处尚未得到证实。医护人员和专业科室也应提高术后区域镇痛的质量。必须严格遵循区域麻醉实践的一般指南。
