Perioperative pain
Perioperative pain
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DOI：
10.1097/01.aco.0000245284.53152.1f
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发表时间：
2006-10-01
影响因子：
2.5
通讯作者：
Lavand'homme, Patricia
中科院分区：
文献类型：
--
作者：
Lavand'homme, Patricia
综述的目的切口疼痛仍然被低估和管理不足，而越来越多的证据表明，围手术期治疗强烈影响患者的结果。本文综述了围手术期疼痛机制的最新进展，并对目前对patients.Recent findingsExperimental models of incisionial pain observed的切口疼痛特征的理解提出了质疑，强调了围手术期疼痛可塑性的具体机制，即感觉处理的敏化，临床上表现为痛觉过敏的发展。然而，对患者感觉系统致敏的长期影响，例如残余疼痛的发展，以及围手术期疼痛管理对致敏的影响，仍然知之甚少，部分原因是大多数试验只评估疼痛的主观体验，（通过评估疼痛强度或镇痛需求）而不是直接测量客观变化使用由手术切口诱导的感觉处理敏化的客观测量的实验研究和最近的临床试验已经显示了痛觉过敏在围手术期疼痛中的重要性。有效的围手术期阻断伤口的伤害性输入以及联合使用抗痛觉过敏和镇痛药物似乎是控制术后疼痛，特别是预防中枢致敏的最佳方法。
Purpose of reviewIncisional pain remains underevaluated and undermanaged while evidence is growing that perioperative treatments strongly influence patients' outcome. The present review examines the recent developments in mechanisms underlying perioperative pain and questions current understanding of incisional pain features observed in patients.Recent findingsExperimental models of incisional pain have highlighted specific mechanisms underlying perioperative pain plasticity, i.e. sensitization of sensory processing, clinically expressed by the development of hyperalgesia. In patients, however, the long-term impact of sensory system sensitization, e.g. development of residual pain, as well as the effects of perioperative pain management on sensitization, are still poorly understood, partly because most of the trials assess only the subjective experience of pain (by evaluation of either pain intensity or analgesic needs) instead of directly measuring objective changes (i.e. hyperalgesia) with quantitative sensory testing.SummaryExperimental studies and recent clinical trials using objective measures of sensory processing sensitization induced by surgical incision have shown the importance of hyperalgesia in perioperative pain. Effective perioperative block of nociceptive inputs from the wound as well as use of antihyperalgesic and analgesic drugs in combination seem the best way to control postoperative pain and specifically to prevent central sensitization.