Multimodal analgesia for controlling acute postoperative pain
Multimodal analgesia for controlling acute postoperative pain
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DOI：
10.1097/aco.0b013e328330373a
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发表时间：
2009-10-01
影响因子：
2.5
通讯作者：
Kroin, Jeffrey S.
中科院分区：
文献类型：
--
作者：
Buvanendran, Asokumar;Kroin, Jeffrey S.
由于阿片类镇痛药的不良反应，急性术后疼痛管理需要多模式镇痛，这可能阻碍恢复；随着门诊手术数量的迅速增加，这一问题日益受到关注。然而，关于多模式镇痛的文献经常显示不同程度的成功，即使研究使用相同的辅助药物。最近发现，非甾体类抗炎药和选择性环氧化酶-2抑制剂一致减少术后阿片类药物的消耗。n -甲基- d -天冬氨酸拮抗剂在研究中产生了不同的结果，这可能是由于给药的剂量和时间。α -2肾上腺素能激动剂作为局部镇痛的辅助剂是有用的，但不能口服。-2- δ受体调节剂如加巴喷丁在多模态镇痛中已经显示出早期有希望的结果。局部麻醉注射在手术部位，虽然不是作为一种先发制人的镇痛，最近已被证明是有益的多模式镇痛。去年没有新的佐剂出现，这有力地减少了阿片类药物的消耗和阿片类药物相关的不良反应。为了实现多模式麻醉的所有预期目标，不断需要探索新的药物组合。
Purpose of reviewMultimodal analgesia is needed for acute postoperative pain management due to adverse effects of opioid analgesics, which can impede recovery; a problem that is of increasing concern with the rapid increase in the number of ambulatory surgeries. Yet, the literature on multimodal analgesia often shows variable degrees of success, even with studies utilizing the same adjuvant medication.Recent findingsNonsteroidal anti-inflammatory drugs and selective cyclooxygenase-2 inhibitors consistently reduce postoperative opioid consumption. The N-methyl-D-aspartate antagonists have produced variable results in studies, which may be due to the dose and timing of drug administration. Alpha-2 adrenergic agonists have been useful as adjuvant for regional analgesia but not when administered orally. The alpha-2-delta receptor modulators such as gabapentin have shown early promising results in multimodal analgesia. Local anesthetic injection at the surgical site, though not as a preemptive analgesic, has recently been demonstrated to be beneficial in multimodal analgesia. No new adjuvants have appeared in the last year, Which robustly reduce opioid consumption and opioid-related adverse effects.SummaryThere is a continuing need to explore new drug combinations to achieve all of the purported goals of multimodal anesthesia.