Preemptive, Preventive, Multimodal Analgesia: What Do They Really Mean?
Preemptive, Preventive, Multimodal Analgesia: What Do They Really Mean?
复制标题
DOI：
10.1097/prs.0000000000000671
复制
发表时间：
2014-10-01
影响因子：
3.6
通讯作者：
Joshi, Girish P.
中科院分区：
文献类型：
--
作者：
Rosero, Eric B.;Joshi, Girish P.
为了改善术后疼痛管理，已经发展了几个概念，包括先发制人的镇痛，预防性镇痛和多模态镇痛。本文将讨论这些概念在改善围手术期疼痛管理中的作用。先发制人的镇痛是指在手术损伤或组织损伤之前进行的镇痛治疗。然而，一些随机临床试验提供了模棱两可的证据，证明了切口前镇痛与切口后镇痛的益处。因此，目前的普遍共识表明，手术后使用先发制人的镇痛并不能转化为一致的临床益处。预防性镇痛是一个更广泛的概念，其中与手术切口相关的镇痛给药时间并不重要。预防性镇痛的目的是尽量减少围手术期产生的有害刺激引起的致敏。多模式镇痛包括两种或两种以上药物的施用，这些药物通过不同的机制提供镇痛。这些药物可以通过相同或不同的途径给药。因此，多模式镇痛的目的是改善疼痛缓解，同时减少阿片类药物的需求和阿片类药物相关的不良反应。目前可用于术后疼痛控制的镇痛方式包括阿片类药物、局部麻醉技术[局部麻醉渗透、周围神经阻滞和神经轴阻滞（硬膜外和椎旁）]、对乙酰氨基酚、非甾体抗炎药、环氧化酶-2特异性抑制剂以及类固醇、氯胺酮、α -2激动剂和抗惊厥药等镇痛辅助药物。
To improve postoperative pain management, several concepts have been developed, including preemptive analgesia, preventive analgesia, and multimodal analgesia. This article will discuss the role of these concepts in improving perioperative pain management. Preemptive analgesia refers to the administration of an analgesic treatment before the surgical insult or tissue injury. Several randomized clinical trials have, however, provided equivocal evidence regarding the benefits of preincisional compared with postincisional analgesic administration. Current general consensus, therefore, indicates that use of preemptive analgesia does not translate into consistent clinical benefits after surgery. Preventive analgesia is a wider concept where the timing of analgesic administration in relation to the surgical incision is not critical. The aim of preventive analgesia is to minimize sensitization induced by noxious stimuli arising throughout the perioperative period. Multimodal analgesia consists of the administration of 2 or more drugs that act by different mechanisms for providing analgesia. These drugs may be administered via the same route or by different routes. Thus, the aim of multimodal analgesia is to improve pain relief while reducing opioid requirements and opioid-related adverse effects. Analgesic modalities currently available for postoperative pain control include opioids, local anesthetic techniques [local anesthetic infiltration, peripheral nerve blocks, and neuraxial blocks (epidural and paravertebral)], acetaminophen, nonsteroidal anti-inflammatory drugs, and cyclooxygenase-2-specific inhibitors as well as analgesic adjuncts such as steroids, ketamine, alpha-2 agonists, and anticonvulsants.