不同镇痛方法在儿童漏斗胸Nuss手术术后的应用

Pain management after Nuss procedure in children with pectus excavatum

背景漏斗胸（pectus excavatum，PE）为最常见的先天性胸廓畸形，Nuss手术为目前常用的手术方式，虽属微创手术，但术后疼痛剧烈，严重影响患儿术后恢复及生活质量。良好的镇痛能促进康复并提高患儿及家属满意度，故Nuss手术术后镇痛具有重要意义。目的对儿童PENuss手术术后镇痛的研究进展予以综述。内容常用的镇痛方式有静脉镇痛、胸段硬膜外镇痛、肋间神经阻滞、椎旁神经阻滞及多模式镇痛等，另外催眠疗法及术后焦虑处理对Nuss术后疼痛也有一定缓解作用。趋向上诉镇痛方法各有优缺点，如何根据患者及医院情况为Nuss手术患儿制定个性化的术后镇痛方案仍待进一步研究。

Background Pectus excavatum（PE） is the most common congenital chest wall deformity and the Nuss procedure is the conventional surgical treatment for this disease. Although the Nuss procedure is minimally invasive, it incurs severe postoperative pain, which is undoubtedly a major factor that affects the postoperative recovery in patients with pectus bar placement. Optimizing pain management in the early post-operative stages is highly demanded to facilitate the recovery of normal function and to improve life-quality, but it is challenging. Objective To summarize postoperative analgesia currently used for pain management in PE patients after Nuss procedure. Content The analgesics applied to relieve postoperative pain in PE patients include opioids, ketamine, lidocaine, and non-steroidal anti-inflammatory drugs. Either single analgesics or combination of several drugs were administered by a variety of strategies, such as, intravenous analgesia, thoracic epidural analgesia, intercostal block, thoracic paravertebral block, and muhimodal anesthesia. The perioperative hypnosis and anxiolyties are also helpful to relieve pain in these patients. The advantage and disadvantage of these analgesia strategies were also discussed. Trend The pain management strategies should be designed according to patient＇s preference and available institutional resources. The optimal strategy suitable for a particular type of patient needs further investigation.