Perioperative Pain Management for Thoracic Surgery: A Multi-Layered Approach.

IF 16.4 1区化学 Q1 CHEMISTRY, MULTIDISCIPLINARY

Accounts of Chemical Research Pub Date : 2024-03-20 DOI:10.1177/10892532241235750

Larry Tong, Che Solla, Jeffrey B Staack, Keith May, Bryant Tran

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Abstract

Cardiothoracic surgeries frequently pose unique challenges in the management of perioperative acute pain that require a multifaceted and personalized approach in order to optimize patient outcomes. This article discusses various analgesic strategies including regional anesthesia techniques such as thoracic epidurals, erector spinae plane blocks, and serratus anterior plane blocks and underscores the significance of perioperative multimodal medications, while providing nuanced recommendations for their use. This article further attempts to provide evidence for the efficacy of the different modalities and compares the effectiveness of the choice of analgesia. The roles of Acute Pain Services (APS) and Transitional Pain Services (TPS) in mitigating opioid dependence and chronic postsurgical pain are also discussed. Precision medicine is also presented as a potential way to offer a patient tailored analgesic strategy. Supported by various randomized controlled trials and meta-analyses, the article concludes that an integrated, patient-specific approach encompassing regional anesthesia and multimodal medications, while also utilizing the services of the Acute Pain Service can help to enhance pain management outcomes in cardiothoracic surgery.

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胸外科围手术期疼痛管理：多层次方法。

心胸手术经常会给围手术期急性疼痛的管理带来独特的挑战，需要采取多方面和个性化的方法才能优化患者的治疗效果。本文讨论了各种镇痛策略，包括胸部硬膜外麻醉、竖脊平面阻滞和前锯肌平面阻滞等区域麻醉技术，并强调了围手术期多模式药物治疗的重要性，同时提供了使用这些药物的细微建议。本文还试图提供不同镇痛模式的疗效证据，并对镇痛选择的有效性进行比较。文章还讨论了急性疼痛服务（APS）和过渡性疼痛服务（TPS）在减轻阿片类药物依赖和术后慢性疼痛方面的作用。此外，还介绍了精准医学作为一种为患者提供量身定制镇痛策略的潜在方法。文章在各种随机对照试验和荟萃分析的支持下得出结论，认为一种综合的、针对患者的方法，包括区域麻醉和多模式药物，同时还利用急性疼痛服务，有助于提高心胸手术的疼痛管理效果。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Accounts of Chemical Research 化学-化学综合

CiteScore

31.40

自引率

1.10%

发文量

312

审稿时长

2 months

期刊介绍： Accounts of Chemical Research presents short, concise and critical articles offering easy-to-read overviews of basic research and applications in all areas of chemistry and biochemistry. These short reviews focus on research from the author’s own laboratory and are designed to teach the reader about a research project. In addition, Accounts of Chemical Research publishes commentaries that give an informed opinion on a current research problem. Special Issues online are devoted to a single topic of unusual activity and significance. Accounts of Chemical Research replaces the traditional article abstract with an article "Conspectus." These entries synopsize the research affording the reader a closer look at the content and significance of an article. Through this provision of a more detailed description of the article contents, the Conspectus enhances the article's discoverability by search engines and the exposure for the research.