脊柱后路开放手术术后多模式镇痛的研究进展

Research Progress of Multimodal Analgesia after Open Spinal Surgery

脊柱后路手术创伤大,术后疼痛明显,有效的术后镇痛是促进患者术后早期康复的主要手段,通过有效的术后疼痛管理,从而将疼痛的伤害性刺激显著缓解,抑制疼痛传导通路的上行传导,降低中枢神经系统中疼痛介质水平,提高疼痛阈值,降低疼痛兴奋性。多模式镇痛管理在脊柱后路手术术后疼痛控制上具有十分重要的意义。目前术后镇痛药物的选择及镇痛方式的选择种类繁多,其作用机制各异,单纯机械化地套用固定模式及用药进行术后镇痛管理,收益甚微。临床需要以患者个体化病情为依据制订镇痛方案,达到最佳术后疼痛控制的目的。

Posterior spinal surgery is traumatic,and postoperative pain is obvious.Effective postoperative analgesia is the main means to promote early recovery of patients after surgery.Through effective postoperative pain management,the noxious stimulation of pain can be significantly relieved,the upward conduction of pain conduction pathways can be inhibited,the level of pain mediators in the central nervous system can be reduced,the pain threshold can be increased,and pain excitability can be reduced.Multimodal analgesic management is of great significance in pain control after posterior spinal surgery.At present,there are many kinds of postoperative analgesic drugs and analgesic methods,and their mechanisms of action are different.The purely mechanical application of fixed models and medication for postoperative analgesic management has little benefit.Clinically,it is necessary to formulate an analgesic plan based on the individual condition of the patient to achieve the goal of optimal postoperative pain control.