在奥地利胸部外科单位的解剖VATS切除后疼痛管理的分析
Florian Ponholzer1, Thomas Schweiger2, Bahil Ghanim3
1Department of Visceral, Transplant and Thoracic Surgery, Center of Operative Medicine, Medical University of Innsbruck, 6020 Innsbruck, Austria.
Journal of clinical medicine
|January 11, 2024
概括
在VATS肺切除术后的术后疼痛管理在奥地利各中心有很大差异. 虽然区域麻醉是常见的,但长时间使用它来减少阿片类药物消费并未标准化,这凸显了对优化治疗指南的需求.
科学领域:
- 胸部外科手术 胸部外科手术
- 疼痛管理 疼痛管理
- 麻醉学 麻醉学
背景情况:
- 术后疼痛显著影响患者的康复和生活质量.
- 目前在VATS切除后的疼痛管理治疗指南并不统一.
- 奥地利胸部外科单位采用各种疼痛管理策略,特别是关于阿片类药物的使用.
研究的目的:
- 分析奥地利解剖视频辅助胸腔镜手术 (VATS) 切除术后的当前疼痛管理方案.
- 调查阿片类药物使用模式和在术后疼痛控制中避免阿片类药物的策略.
主要方法:
- 开发了一个问卷来收集关于区域麻醉,术后止痛药和疼痛管理协议的数据.
- 该调查分发给所有奥地利胸部外科病房,在十二个部门中,有九个部门的响应率.
主要成果:
- 所有响应中心在VATS手术期间都使用区域麻醉.
- 四个中心在50%以上的患者中使用外周止痛或肋间导管用于术后区域麻醉.
- 疼痛管理方法的范围从阿片类药物限制性疗法到依赖视觉模拟量表 (VAS) 或固定阿片类药物时间表,在NSAID和止痛药 (甲米醇,皮里特拉米德) 使用方面存在显著差异.
结论:
- 在VATS解剖肺切除后的术后疼痛治疗中存在显著的异质性.
- 虽然区域麻醉被广泛使用,但其长期应用用于阿片类药物减少,如手术后增强恢复 (ERAS) 协议所建议的那样,并未得到一致的实施.
- 需要进一步的研究,以建立基于证据的标准化协议,以实现最佳的术后疼痛管理.
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