多模式镇痛在加速康复外科中的作用

Role of multimodal analgesia in enhanced recovery after surgery

加速康复外科(ERAS)是以循证医学依据为基础,以减少手术患者的生理及心理的创伤应激为目的,通过外科、麻醉、护理、营养等多学科协作,对围手术期处理的临床路径予以优化,从而减少围手术期应激反应及术后并发症,缩短住院时间,促进患者康复的一种理念。这一优化的临床路径贯穿于住院前、围手术期及出院后,强调要以服务患者为中心。术后疼痛是影响患者恢复的一大因素,不仅影响术后住院天数,同时也会影响患者远期的生活质量。因此,充分止痛是快速康复计划中一个重要环节,也是早期下床活动及早期口服营养的必要前提,能够减少手术应激反应。目前多推荐使用多模式镇痛(MMA)。本文主要讨论外科手术后疼痛管理以及多模式镇痛在术后疼痛管理中的意义,阐述了阿片类药物、非甾体类抗炎药(NSAIDS)、其他辅助镇痛药物及镇痛技术的使用现状。

Based on evidence-based medicine, with the help of multidisciplinary collaborations such as surgery, anesthesia, nursing, and nutrition, enhanced recovery after surgery(ERAS) optimizes the clinical pathway for perioperative management, in order to reduce perioperative stress response and postoperative complications, relieve the physical and psychological traumatic stress of surgical patients, shorten hospital stay, and promote patients" recovery. The optimized clinical pathway involves the whole process from pre-hospital, perioperative, to post-discharge, with an emphasis on serving patients. Postoperative pain is a major factor affecting the recovery of patients, which affects not only the length of hospital stays, but also patients’ long-term quality of life. Therefore, adequate pain relief is an important part of EARS, a prerequisite for early bed-out activities and early oral nutrition, and a meaningful way to reduce the surgical stress response. Multimodal analgesia(MMA) is currently recommended. This article focuses on postoperative pain management and multimodal analgesia, and reviews the current status of opioids, non-steroidal anti-inflammatory drugs(NSAIDS), other analgesic drugs, and analgesic techniques.