儿童及青少年脊柱畸形矫形围术期疼痛管理的研究进展

Progress in perioperative pain management of pediatric and adolescent spinal deformity corrective surgery

目的总结儿童及青少年脊柱畸形矫形围术期疼痛管理方案的相关研究成果。方法查阅近年国内外儿童及青少年脊柱畸形矫形围术期疼痛管理的相关文献,从常用镇痛药物、给药方式和镇痛方案设计方面进行总结分析。结果对于儿童及青少年脊柱畸形矫形围术期疼痛管理方案,常用的药物包括非甾体类抗炎药、阿片类药物、抗癫痫类药物、肾上腺素受体激动剂和局部麻醉药等;给药方式除了常规的口服、静脉注射、肌肉注射等,还包括静脉自控镇痛、硬膜外注射、鞘内注射等。多模式镇痛方案则是疼痛管理的主流方案。结论目前临床上已有多种儿童及青少年脊柱畸形矫形围术期镇痛方案,但对于最佳方案仍无定论。设计出安全、有效的镇痛方案仍需要进一步探讨研究。

Objective To review the advances in perioperative pain management of pediatric and adolescent spinal deformity corrective surgery. Methods Regular analgesics, drug administrations, and analgesic regimens were reviewed and summarized by consulting domestic and overseas related literatures about perioperative pain management of pediatric and adolescent spinal deformity corrective surgery in recent years. Results As for perioperative analgesis regimens of pediatric and adolescent spinal deformity corrective surgery, regular analgesics include non-steroidal antiinflammatory drugs, opioids, antiepileptic drugs, adrenergic agonists, and local anesthetic, etc. Besides drug administration by mouth, intravenous injection, and intramuscular injection, the administration also includes patient controlled analgesia, epidural injection, and intrathecal injection. Multimodal analgesia is the most important regimen currently. Conclusion Heretofore, a number of perioperative pain managements of pediatric and adolescent spinal deformity corrective surgery have been applied clinically, but the ideal regimen has not been developed. To design a safe and effective analgesic regimen needs further investigations.