胸部外科手术中术期间止痛的最新进展:叙述性综述
John Mitchell1,2, Céline Couvreur3, Patrice Forget4,5,6,7
1Department of Anesthesiology, Catholic University of Louvain, University Hospital CHU UCL Namur, Mont-Godinne, 5530 Yvoir, Belgium.
Journal of clinical medicine
|January 11, 2025
概括
新的区域麻醉技术在胸部手术后提供有效的疼痛缓解,为传统的外周麻醉方法提供了更少并发症的替代方案. 这些进展改善了患者的康复,并降低了风险.
科学领域:
- 麻醉学 麻醉学
- 胸部外科手术 胸部外科手术
- 疼痛管理 疼痛管理
背景情况:
- 胸部手术会导致严重的术后疼痛,影响恢复和增加发病率.
- 外周麻醉是传统的,但有缺点,如技术挑战和并发症.
- 需要替代的止痛策略,以获得更好的患者结果.
研究的目的:
- 对胸部外科手术的外科手术期间止痛策略的最新进展进行审查.
- 评估区域麻醉技术的疗效,安全性和患者的结果.
- 将这些技术与传统的外周麻醉进行比较.
主要方法:
- 关于胸部手术疼痛管理的当前文献的叙述性综述.
- 专注于区域麻醉技术:准脊椎阻塞 (PVBs),直立脊柱平面阻塞 (ESPBs),肋间阻塞和脊柱前部阻塞.
- 评估疗效,安全性和对患者康复的影响.
主要成果:
- PVBs提供有效的单边止痛,系统性并发症比外围注射更少.
- ESPBs为胸部手术提供了一个更安全的,超声波导向的替代方案.
- 肋间和骨前部块显示有前途,但有局限性或特定的应用.
- 微创手术和多式疗法可以改善疼痛控制.
结论:
- 替代区域技术提供类似的疼痛缓解,以减少并发症.
- 这些方法在胸部手术疼痛管理中越来越重要.
- 量身定制的多模式策略和协作护理对于最佳康复和降低发病率至关重要.
相关概念视频
Local Anesthetics: Clinical Application as Epidural Anesthesia
409
Epidural anesthetics are administered in the fat-filled epidural space, the outermost part of the spinal canal. This technique is commonly employed for pain management and anesthesia during lower abdomen and pelvis surgeries or labor and delivery.
Since epidural anesthetics can be infused through an epidural catheter, all types of drugs, including short-acting ones, can be administered. Chloroprocaine and lidocaine are examples of short and long-duration anesthetics, respectively. Bupivacaine...
Since epidural anesthetics can be infused through an epidural catheter, all types of drugs, including short-acting ones, can be administered. Chloroprocaine and lidocaine are examples of short and long-duration anesthetics, respectively. Bupivacaine...
409
General Anesthesia: Overview
190
Anesthesia is a medical procedure that uses drugs for CNS suppression to enable painless surgeries and procedures. The selection of anesthetics is influenced by their pharmacokinetic properties, side effects, and patient characteristics. Various types of anesthesia include general, local, regional, spinal, and inhalational.
General anesthesia induces unconsciousness in the whole body, while the others target specific areas or sensations. It is administered to minimize adverse effects, maintain...
General anesthesia induces unconsciousness in the whole body, while the others target specific areas or sensations. It is administered to minimize adverse effects, maintain...
190
Analgesia and Pain Management
490
Pain is critical to various clinical pathologies, provoking an urgent need for effective management. Pain, whether acute or chronic, is a complex neurochemical process. Its alleviation depends on the type, with nonopioid analgesics effective for mild to moderate pain, such as musculoskeletal or inflammatory pain, while neuropathic pain responds best to anticonvulsants, tricyclic antidepressants, or serotonin/norepinephrine reuptake inhibitors. For severe acute or chronic pain, opioids may be...
490
Local Anesthetics: Clinical Application as Spinal Anesthesia
576
Spinal anesthetics are given during lower abdomen and limb surgeries to block sensory and motor neurons. They are administered in the mid to low lumbar regions, primarily acting on the cauda equina's nerve roots. The blockade level depends on the local anesthetic (LA) concentration. Usually, low LA concentrations are sufficient to block sensory fibers, while only high LA concentrations block motor fibers. Other factors like injection volume and speed, the patient's posture, and the drug...
576
Opioid Analgesics: Synthetic and Semisynthetic Opioids
218
Synthetic and semisynthetic opioids are pivotal in pain management and tackling opioid addiction. Semisynthetic opioids, including morphinans (morphine derivatives), oxycodone, oxymorphone, hydrocodone, and hydromorphone, have improved pharmacokinetic profiles compared to morphine. Additionally, heroin and 6-MAM (6-Monoacetylmorphine) show better CNS penetration than morphine due to heightened lipid solubility. Hydromorphone, a potent opioid, undergoes hepatic metabolism to form the active...
218
Endoscopic Studies II: Thoracocentesis
199
Thoracentesis(Thoracocentesis), commonly known as pleural tap, is a medical procedure where a 22 gauge needle is inserted into the pleural space, the area between the lung and chest wall. This procedure is commonly performed to diagnose or treat various respiratory disorders.
Description
Excess pleural fluid or air may accumulate in some respiratory disorders in the thoracic cavity. To treat pleural effusion, a physician conducts thoracentesis by carefully piercing the chest wall and entering...
Description
Excess pleural fluid or air may accumulate in some respiratory disorders in the thoracic cavity. To treat pleural effusion, a physician conducts thoracentesis by carefully piercing the chest wall and entering...
199


