围手术期镇痛治疗-帕瑞昔布钠.ppt

* 250 patients who had undergone surgical procedures (in- and outpatient) in the past year completed a questionnaire about their experiences with pain before and after surgery. The most common concern that patients expressed prior to surgery was experiencing pain (59%), which was cited more often than concerns about whether the surgery would improve their condition (51%) or whether they would fully recover (46%). 58% of the sample reported pain prior to surgery. Despite receiving treatment for pain, 82% reported pain in the immediate postsurgical period (end of surgery up to 2 weeks after discharge) and 75% reported pain after discharge. More than two thirds of patients reported pain of moderate to severe intensity, and extreme pain was reported by 18% overall and 8% after discharge. Apfelbaum JL, Chen C, Mehta SS, Gan TJ. Postoperative pain experience: results from a national survey suggest postoperative pain continues to be undermanaged. Anesth Analg. 2003;97:534-540. * Nonselective NSAIDs inhibit both COX-1 and COX-2. By inhibiting COX-1, however, NSAIDs can reduce platelet aggregation and increase bleeding risk. NSAIDs demonstrate a ceiling effect in pain relief; further dose escalation increases adverse effects.1,2 While nonselective NSAIDs are considered efficacious in managing pain, physicians may be reluctant to use them due to their risks of CV, skin, GI, and antiplatelet effects3-5 Some of the GI side effects of NSAIDs can be mitigated by adding a proton pump inhibitor to a patient’s drug regimen. However, concomitant treatment with a gastroprotective agent incurs greater expense and adds to the complexity of treatment6 NSAIDs may mask fever. After surgery, the site of incision should be carefully observed to detect signs of infection References: 1. Power I, Barratt S. Analgesic agents for the postoperative period. Nonopioids. Surg Clin North Am. 1999;79:275-295. 2. Atcheson R, Rowbotham DJ. Pharmacology of acute and chronic pain. In: Rawal N, ed. Manag