Poorly controlled postoperative pain: prevalence, consequences, and prevention.
Poorly controlled postoperative pain: prevalence, consequences, and prevention.
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DOI：
10.2147/jpr.s144066
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发表时间：
2017
影响因子：
2.7
通讯作者：
Gan TJ
中科院分区：
文献类型：
--
作者：
Gan TJ
本综述概述了术后疼痛控制不良的临床问题和治疗方法，可能有助于解决这一常见的未解决的卫生保健挑战。在美国，超过80%的患者术后疼痛没有得到充分的控制，尽管这一比例因手术类型、使用的镇痛/麻醉干预以及术后时间等因素而异。术后急性疼痛控制不佳与发病率增加、功能和生活质量受损、恢复时间延迟、阿片类药物使用时间延长以及卫生保健费用增加有关。此外，手术中或手术后急性疼痛的存在和强度可以预测慢性疼痛的发展。围手术期需要更有效的镇痛/麻醉措施，以防止进展为持续性疼痛。尽管临床结果不一致，但一些局部麻醉剂和非阿片类镇痛药的研究表明，作为预防性干预措施，它们有潜在的益处。传统的阿片类药物仍然是处理急性术后疼痛的标准护理；然而，阿片类药物相关不良事件的风险会限制最佳镇痛剂量，导致术后急性疼痛控制不佳。一些新的阿片类药物已经开发出来，通过选择性地参与与镇痛相关的细胞内通路来调节μ受体活性，而不是那些与不良事件相关的通路，创造了比非选择性传统阿片类药物更宽的治疗窗口。在临床研究中，与吗啡相比，一种新型μ受体g蛋白通路选择性调节剂——水蛭碱（TRV130）产生了快速的术后镇痛，并且减少了不良事件的发生率。
This review provides an overview of the clinical issue of poorly controlled postoperative pain and therapeutic approaches that may help to address this common unresolved health-care challenge. Postoperative pain is not adequately managed in greater than 80% of patients in the US, although rates vary depending on such factors as type of surgery performed, analgesic/anesthetic intervention used, and time elapsed after surgery. Poorly controlled acute postoperative pain is associated with increased morbidity, functional and quality-of-life impairment, delayed recovery time, prolonged duration of opioid use, and higher health-care costs. In addition, the presence and intensity of acute pain during or after surgery is predictive of the development of chronic pain. More effective analgesic/anesthetic measures in the perioperative period are needed to prevent the progression to persistent pain. Although clinical findings are inconsistent, some studies of local anesthetics and nonopioid analgesics have suggested potential benefits as preventive interventions. Conventional opioids remain the standard of care for the management of acute postoperative pain; however, the risk of opioid-related adverse events can limit optimal dosing for analgesia, leading to poorly controlled acute postoperative pain. Several new opioids have been developed that modulate μ-receptor activity by selectively engaging intracellular pathways associated with analgesia and not those associated with adverse events, creating a wider therapeutic window than unselective conventional opioids. In clinical studies, oliceridine (TRV130), a novel μ-receptor G-protein pathway-selective modulator, produced rapid postoperative analgesia with reduced prevalence of adverse events versus morphine.