Impact of Preemptive Analgesia on Recovery From Surgery

在美国，每年有超过2300万例外科手术伴随着严重且治疗不当的疼痛。几乎2/3的患者认为术后疼痛是他们术前最大的恐惧。除了越来越多的证据表明疼痛会干扰呼吸、血压调节等生理功能外，与手术相关的疼痛还会限制患者照顾自己的能力，可能会延长，可能导致慢性疼痛综合征，并可能影响患者推迟或推迟可能挽救生命的手术的决定。最近的证据表明，大手术后的残余疼痛比最初认识到的更常见，并且这种疼痛与功能和自我健康感知的显着下降有关。疼痛刺激会引发一系列反应，使神经系统变得敏感，从而使随后的疼痛刺激被更强烈地感知，甚至通常的无痛刺激也会引起疼痛。先发制人的镇痛是一种干预措施，旨在通过在疼痛刺激开始前开始镇痛方案来防止由疼痛刺激产生的神经系统敏化。有明确的实验室证据和越来越多的临床证据表明，先发制人的镇痛可以减少手术后的疼痛和镇痛需求，我们最近的研究表明，这种益处可以在出院后很长一段时间内观察到，表现为活动增加和残余疼痛减少。其中一个最常见和临床有效的先发制人的镇痛方案涉及硬膜外导管的使用。在手术开始前将足够剂量的药物引入硬膜外腔并持续到术后，尽管有足够水平的全身麻醉，但似乎可以限制神经系统的致敏。然而，先发制人的硬膜外镇痛在术前、术中和术后都需要额外的医生和其他资源，因此，只有在疗效明显的情况下，这种干预措施才会得到个体医生和第三方支付者的支持。本应用程序考虑了在接受常见腹部大手术的一般健康成人患者中积极先发制人硬膜外镇痛的短期和长期成本和收益。住院期间和出院后的疼痛、活动水平、护理需求和恢复正常功能将进行定量和经济评估。这些结果将量化积极的围手术期疼痛管理所起的作用，将进一步将围手术期疼痛的减少与预后联系起来，并且通过量化大手术后恢复的影响，将允许更合理地分配稀缺的医疗资源，以有效地管理急性疼痛。

Pain, often severe and inadequately treated, accompanies the more than 23 million surgical procedures performed annually in the U,S. Almost 2/3 of patients cite postoperative pain as their major preoperative fear. Apart from the mounting evidence that pain interferes with physiologic functions such as breathing, blood pressure regulation, etc., the pain associated with surgery limits the ability of patients to care for themselves, can be prolonged, may lead to chronic pain syndromes, and could possibly influence a patient's decision to delay or postpone potentially lifesaving surgery. Recent evidence indicates that residual pain following major surgery is more common than first appreciated, and that this pain is associated with significant decreases in functionality and self-perception of health. Painful stimuli initiate a cascade of responses which sensitize the nervous system so that subsequent painful stimuli are perceived with greater intensity and even typically painless stimuli can elicit pain. Preemptive analgesia is an intervention designed to prevent the sensitization of the nervous system produced by painful stimuli by beginning the analgesic regimen before the onset of pain stimuli. There is a definitive body of laboratory evidence and a growing body of clinical evidence that preemptive analgesia can reduce pain and analgesic needs following surgery, and our recent research indicates that this benefit can be observed in humans long after discharge from the hospital in the form of increased activity and decreased residual pain. One of the most common and clinically effective preemptive analgesic regimens involves the use of an epidural catheter. Adequate doses of medications introduced into the epidural space before the start of surgery and continued into the postoperative period appear to limit sensitization of the nervous system despite adequate levels of general anesthesia. However, preemptive epidural analgesia requires additional physician and other resources before, during and after surgery, Consequently, such an intervention will be supported by individual practitioners and third-party payers only in the face of demonstrable efficacy. This application considers the short- and long-term costs and benefits of aggressive preemptive epidural analgesia in generally healthy adult patients undergoing a common major abdominal surgical procedure. Pain during hospitalization and after discharge, activity levels, nursing needs, and the return to normal function will be quantitatively and economically assessed. These results will quantify the role played by aggressive perioperative pain management, will further link reductions in perioperative pain and outcome, and by quantifying the impact of recovery from major surgery will permit more rational allocation of scarce healthcare resources to effective strategies for acute pain management.