周围神经阻滞后的反跳性疼痛:综述。

IF 13 1区 医学 Q1 PHARMACOLOGY & PHARMACY
Drugs Pub Date : 2025-05-22 DOI:10.1007/s40265-025-02196-8
Wenqin Yin, Dan Luo, Haiqi Mi, Zhimin Ren, Lianling Li, Zhidong Fan, Jingyan Lin
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引用次数: 0

摘要

由于超声成像技术的不断进步,周围神经阻滞(PNB)现在是临床麻醉中常用的镇痛治疗方法,可以提供清晰的神经图像。基于周围神经阻滞的多模式镇痛正在取代传统的基于阿片类药物的镇痛策略。然而,在神经阻滞效应消除后,一些患者会出现反跳性疼痛(RP),这加剧了痛苦。如果RP发现和治疗太晚,PNB作为围手术期镇痛药的益处可能会完全被否定,即使它可以用镇痛药及时控制。本文就pnb后RP的定义、临床体征、危险因素、病理生理及预防进行综述。目前,PNB后RP的机制尚不清楚,但不同类型的RP可能在疼痛传递途径中具有相似的机制。在这篇综述中,我们确定了RP的特征,并试图确定高危因素。在已确定的预防和减少RP发生率的多种手段中,地塞米松辅助的单次阻滞是一种可靠的方案,但目前,导管的应用将是一种更可靠的减少RP的方法。本综述还对临床麻醉下神经阻滞作为辅助镇痛药的正确使用提出了建议。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Rebound Pain After Peripheral Nerve Block: A Review.

Peripheral nerve block (PNB) is now a commonly used analgesic treatment in clinical anesthesia owing to ongoing advancements in ultrasound imaging technology, which provides clear images of the nerves. Multimodal analgesia based on peripheral nerve blocks is replacing the conventional opioid-based analgesic strategy. However, after the nerve block effect is removed, some patients experience rebound pain (RP), which exacerbates suffering. The benefits of PNB as a perioperative analgesic may be completely negated if RP is discovered and treated too late, even if it can be promptly managed with analgesics. The definitions, clinical signs, risk factors, pathophysiology, and prevention of RP after PNBs are reviewed in this article. At present, the mechanism of RP after PNB is still unclear, but different types of RP may share similar mechanisms in the pain transmission pathway. In this review, we have determined the characteristics of RP and tried to identify the high-risk factors. Among the many means of preventing and reducing the incidence of RP identified, a single block with adjuvant dexamethasone is a reliable regimen, but for the time being, the application of a catheter would be a more reliable method of reducing RP. This review also provides recommendations for the proper use of nerve blocks as supplemental analgesics under clinical anesthesia.

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来源期刊
Drugs
Drugs 医学-毒理学
CiteScore
22.70
自引率
0.90%
发文量
134
审稿时长
3-8 weeks
期刊介绍: Drugs is a journal that aims to enhance pharmacotherapy by publishing review and original research articles on key aspects of clinical pharmacology and therapeutics. The journal includes: Leading/current opinion articles providing an overview of contentious or emerging issues. Definitive reviews of drugs and drug classes, and their place in disease management. Therapy in Practice articles including recommendations for specific clinical situations. High-quality, well designed, original clinical research. Adis Drug Evaluations reviewing the properties and place in therapy of both newer and established drugs. AdisInsight Reports summarising development at first global approval. Moreover, the journal offers additional digital features such as animated abstracts, video abstracts, instructional videos, and podcasts to increase visibility and educational value. Plain language summaries accompany articles to assist readers with some knowledge of the field in understanding important medical advances.
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