近十年来开胸微创手术术后镇痛的发展。

IF 2.6 3区 医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS
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引用次数: 0

摘要

引言:无论是通过微创还是传统的开放技术,由于肋间肌和呼吸肌的切开、肋骨损伤或切除以及外科引流管的放置,胸部手术通常是最痛苦的手术之一。与镇痛不良相关的一些更严重的并发症包括重症监护室(ICU)住院时间延长、机械通气、肺炎和慢性术后疼痛综合征的发展。在过去的几十年里,在认识到多模式镇痛技术的重要性方面取得了很大进展。这些可能包括各种区域麻醉技术,如硬膜外麻醉、筋膜平面阻滞和胸膜内导管,以及阿片类药物和阿片类物质保留口服方案的使用。这篇文章提供了一篇关于胸部手术后疼痛管理的最新综述,强调了多模式技术和增强的恢复途径。方法:在我们的综述中,我们纳入了2010年至2022年间发表的文章。PubMed和Google Scholar使用关键词胸部、心脏、疼痛控制、胸部硬膜外镇痛、筋膜平面阻滞、多模式镇痛和ERAS在胸部手术中进行了研究。随后审查了100多篇文章。我们排除了非英文文章和与心脏或胸部手术无关的文章。最终,53篇文章被纳入综述,包括临床试验、病例系列和回顾性队列研究。结果:胸部和心脏手术中使用的各种疼痛控制方法包括阿片类药物和阿片类保留药物,如对乙酰氨基酚和加巴喷丁,以及区域技术,如筋膜平面阻滞和硬膜外麻醉。多模式麻醉结合区域性和阿片类镇痛剂及其在强化恢复方案中的组合被证明可以提供足够的疼痛控制,减少阿片类药物的消耗,并缩短住院时间。结论:术后疼痛控制仍然是胸外科患者护理中最大的挑战之一。镇痛方案必须针对每个患者进行个性化。多模式镇痛仍是金标准;然而,仍有必要进行更多的研究。通过合适的区域技术,找到阿片类和非阿片类止痛药以及局部麻醉剂的最佳组合,将改善疗效,并使患者成功康复。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Developments in Postoperative Analgesia in Open and Minimally Invasive Thoracic Surgery Over the Past Decade

Whether through minimally invasive or conventional open techniques, thoracic surgery is often reported to be one of the most painful surgical procedures due to the incision of intercostal and respiratory muscles, rib injury or resection, and placement of surgical drains. Some of the more severe complications related to poor analgesia include prolonged intensive care unit stay, mechanical ventilation, pneumonia, and the development of chronic postoperative pain syndromes. Over the past few decades, much progress has been made in recognizing the importance of multimodal analgesic techniques. These may include a variety of regional anesthetic techniques such as epidural anesthesia, fascial plane blocks, and intrapleural catheters, as well as the utilization of opioid and opioid-sparing oral regimens. This article provides an up-to-date review of pain management following thoracic surgery, emphasizing multimodal techniques and enhanced recovery pathways. In our review, we included articles published between 2010 and 2022. PubMed and Google Scholar were researched using the keywords thoracic, cardiac, pain control, thoracic epidural analgesia, fascial plane blocks, multimodal analgesia, and Enhanced Recovery after Surgery in thoracic surgery. Over 100 articles were then reviewed. We excluded articles not in English and articles that were not pertinent to cardiac or thoracic surgery. Eventually, 53 articles were included in the review, composed of clinical trials, case series, and retrospective cohort studies. A variety of pain control methods employed in thoracic and cardiac surgery range from opioids and opioid-sparing medications, such as acetaminophen and gabapentin, to regional techniques, such as fascial plane blocks to epidural anesthesia. Multimodal anesthesia combining regional and opioid-sparing analgesics and their combination in enhanced recovery protocols were shown to provide adequate pain control, decrease opioid consumption and lead to shorter lengths of stay. Postoperative pain control remains one of the biggest challenges in the care of thoracic surgery patients. Analgesic plans must be individualized for each patient. Multimodal analgesia remains the gold standard; however, more studies are still warranted. Finding the optimal combination of opioid and non-opioid pain medication and local anesthetic delivered via suitable regional technique will improve the outcomes and lead to successful patient recovery.

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来源期刊
Seminars in Thoracic and Cardiovascular Surgery
Seminars in Thoracic and Cardiovascular Surgery Medicine-Pulmonary and Respiratory Medicine
CiteScore
5.80
自引率
0.00%
发文量
324
审稿时长
12 days
期刊介绍: Seminars in Thoracic and Cardiovascular Surgery is devoted to providing a forum for cardiothoracic surgeons to disseminate and discuss important new information and to gain insight into unresolved areas of question in the specialty. Each issue presents readers with a selection of original peer-reviewed articles accompanied by editorial commentary from specialists in the field. In addition, readers are offered valuable invited articles: State of Views editorials and Current Readings highlighting the latest contributions on central or controversial issues. Another prized feature is expert roundtable discussions in which experts debate critical questions for cardiothoracic treatment and care. Seminars is an invitation-only publication that receives original submissions transferred ONLY from its sister publication, The Journal of Thoracic and Cardiovascular Surgery. As we continue to expand the reach of the Journal, we will explore the possibility of accepting unsolicited manuscripts in the future.
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