围术期镇痛新进展.ppt

手术后疼痛控制ThomasJ.Schnitzer.ClinRheumatol(2006)25(Suppl1):S22-S29紧邻术后阶段（术后48h内）“逐步下降”，多模式途径（自术后第3天）背景：对乙酰氨基酚+COX-2抑制剂局部麻醉/封闭根据疼痛强度可按需加用：阿片类合并药更强的阿片类药基线：对乙酰氨基酚+NSAID、COX-2抑制剂+短效PRN阿片类合并药+曲马多+PRN口服吗啡作为救援疗法中度疼痛强度重度康复期疼痛控制ThomasJ.Schnitzer.ClinRheumatol(2006)25(Suppl1):S22-S29运动/炎性疼痛疼痛强度中度重度√NSAID/COX-2抑制剂√+/-短效弱阿片类/曲马多√+/-强阿片类020304050601NSAIDs（非选择性NSAIDs和选择性COX-2抑制剂）阿片类药物（吗啡、芬太尼、舒芬太尼）钙通道阻滞剂（加巴喷丁、普瑞巴林）局麻药（布比卡因、左旋布比卡因、罗哌卡因）α2受体激动剂（可乐定）NMDA受体拮抗剂（氯胺酮、右美沙芬）围术期常用镇痛药物药物镇痛靶点RobertHallivis,etal.ClinPodiatrMedSurg.2008(25)443-463.250patientswhohadundergonesurgicalprocedures(in-andoutpatient)inthepastyearcompletedaquestionnaireabouttheirexperienceswithpainbeforeandaftersurgery.Themostcommonconcernthatpatientsexpressedpriortosurgerywasexperiencingpain(59%),whichwascitedmoreoftenthanconcernsaboutwhetherthesurgerywouldimprovetheircondition(51%)orwhethertheywouldfullyrecover(46%).58%ofthesamplereportedpainpriortosurgery.Despitereceivingtreatmentforpain,82%reportedpainintheimmediatepostsurgicalperiod(endofsurgeryupto2weeksafterdischarge)and75%reportedpainafterdischarge.Morethantwothirdsofpatientsreportedpainofmoderatetosevereintensity,andextremepainwasreportedby18%overalland8%afterdischarge.ApfelbaumJL,ChenC,MehtaSS,GanTJ.Postoperativepainexperience:resultsfromanationalsurveysuggestpostoperativepaincontinuestobeundermanaged.AnesthAnalg.2003;97:534-540.250patientswhohadundergonesurgicalprocedures(in-andoutpatient)inthepastyearcompletedaquestionnaireabouttheirexperienceswithpainbeforeandaftersurgery.Themostcommonconcernthatpatientsexpressedpriortosurgerywasexperiencingpain(59%),whichwascitedmoreoftenthanconcernsaboutwhetherthesurgerywouldimprovetheircondition(51%)orwhethertheywouldfullyrecover(46%).58%of