围手术期麻醉

І.І. Lisnyi
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引用次数: 0

摘要

背景。确保足够的镇痛是术后快速恢复的先决条件。改善急性疼痛的管理对于确保早期活动所需的安全有效的镇痛和避免由于镇痛不足导致的器官功能障碍是重要的。为此,采用多模态镇痛(MMA)。它包括阿片类镇痛药,非甾体抗炎药(NSAID),扑热息痛或metamizole,局部麻醉剂和辅助药物。目标。介绍围手术期镇痛的现代观点。材料和方法。对这一问题的文献资料进行分析。结果和讨论。MMA涉及阿片类药物保留方法(在不降低镇痛质量的情况下减少阿片类药物的剂量)、程序和患者特异性。术后恢复改善方案包括几个项目,其中三个项目与缩短治疗时间有关,即多模式预防术后恶心和呕吐、围手术期使用非甾体抗炎药和术后阿片类药物方案。非甾体抗炎药和扑热息痛联合使用比单独使用这些药物效果更好。在正确的剂量下,扑热息痛(Infulgan,“Yuria-Pharm”)是一种有效的非阿片类镇痛药,可长期治疗急性疼痛,副作用最小。术前和术中使用扑热息痛在一些指南中被推荐。局部麻醉剂的静脉注射是MMA的另一个重要组成部分。2016年Cochrane综述显示,围手术期长期静脉输注利多卡因可显著减少术后对阿片类药物的需求。然而,对10项随机对照试验的荟萃分析发现,围手术期静脉注射利多卡因与安慰剂在通过视觉模拟量表评估的术后疼痛和阿片类药物需求方面没有差异(Rollins k.e., 2020)。近年来的其他研究也得到了类似的结果。在MMA中加入尼福泮可以减少阿片类药物的剂量。nefopam, paracetamol和deksketoprofen的使用可以显著减少吗啡的使用。由于该问题的多因素性质,单次治疗无法充分控制疼痛和术后恢复。建议使用MMA,但没有针对特定手术的最佳镇痛药组合的建议。扑热息痛和非甾体抗炎药的联合使用是MMA的黄金标准。结论:1。手术后,病人应充分麻醉。2. 为了达到最佳的非阿片类镇痛效果,建议使用MMA。3.NSAID、扑热息痛、nefopam和局部技术是MMA的重要组成部分。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Perioperative anesthesia
Background. Ensuring adequate analgesia is a prerequisite for rapid recovery after surgery. Improving the management of acute pain is important to ensure the safe and effective analgesia needed for early mobilization and for avoidance of organ dysfunction due to inadequate analgesia. For this purpose, multimodal analgesia (MMA) is used. It includes opioid analgesics, nonsteroidal anti-inflammatory drugs (NSAID), paracetamol or metamizole, local anesthetics and ancillary drugs. Objective. To describe modern views on perioperative analgesia. Materials and methods. Analysis of literature data on this issue. Results and discussion. MMA involves an opioid-preserving approach (reducing the dose of opioids without reducing the quality of analgesia), procedure and patient specificity. The postoperative recovery improvement program includes several items, three of which have been associated with a reduction in treatment duration, namely, multimodal prevention of postoperative nausea and vomiting, perioperative NSAID use, and post-operative opioid protocol. The combined use of NSAID and paracetamol provides a better result than the use of each of these drugs alone. At the correct dose, paracetamol (Infulgan, “Yuria-Pharm”) is an effective non-opioid analgesic for the treatment of acute pain with minimal side effects for a long time. Pre- and intraoperative administration of paracetamol is recommended in a number of guidelines. Intravenous administration of local anesthetics is an another important component of MMA. The 2016 Cochrane review showed that long-term intravenous perioperative infusion of lidocaine significantly reduced the postoperative need for opioids. However, the meta-analysis of 10 randomized controlled trials found that perioperative intravenous lidocaine did not differ from placebo in post-operative pain assessed with the help of a visual analog scale and in opioid requirements (Rollins K.E., 2020). Similar results have been obtained in other studies in recent years. Inclusion of nefopam in MMA can reduce the dose of opioids. The use of nefopam, paracetamol and deksketoprofen makes it possible to dramatically reduce the use of morphine. Neither pain nor postoperative recovery can be adequately controlled with a single treatment due to the multifactorial nature of the problem. It is recommended to use MMA, but there are no recommendations for optimal combinations of analgesics for specific procedures. Administration of paracetamol and NSAID in combination with the use of regional techniques is a golden standard of MMA. Conclusions. 1. After the surgery, the patient should be adequately anesthetized. 2. To achieve optimal, preferably non-opioid, analgesia, it is recommended to use MMA. 3. NSAID, paracetamol, nefopam and regional techniques are the important components of MMA.
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