血手术的前景指南:一个系统的审查和特定程序的术后疼痛管理建议
Alexis Bikfalvi1, Charlotte Faes1, Stephan M Freys1
1From the Department of Anaesthesia, University Hospital of Lausanne and University of Lausanne, Lausanne, Switzerland (AB, EA), the Department of Cardiovascular Sciences and Department of Anaesthesia, University Hospitals of the KU Leuven, Belgium (CF, MvdV), the Department of Surgery, DIAKO Ev. Diakonie-Krankenhaus Bremen, Germany (SMF), the Department of Anaesthesiology and Pain Management, University of Texas Southwestern Medical Center, Dallas, Texas, USA (GPJ).
经过带切除术后管理疼痛的最新建议强调局部治疗方法,如美特罗尼达,迪尔提亚泽姆,苏克拉酸盐和甘三酸盐. 毒素和尾神经阻塞也可以有效缓解术后疼痛.
科学领域:
- 疼痛管理 疼痛管理
- 外科手术的结果
- 基于证据的医学基于证据的医学.
背景情况:
- 切除术经常导致中度至重度的术后疼痛.
- 有效的疼痛管理对于患者在带切除术后的康复和满意度至关重要.
研究的目的:
- 系统地审查现有文献,并更新PROSPECT (手术后特殊疼痛管理) 准则.
- 提供基于证据的建议,以优化经过瘤切除术后的疼痛管理.
主要方法:
- 使用PROSPECT方法进行了系统审查.
- 从主要数据库 (MEDLINE,EMBASE,Cochrane) 中确定了2016年1月至2022年2月期间发表的相关随机对照试验 (RCT).
主要成果:
- 84个RCT和19个系统性审查/元分析符合纳入标准.
- 有效的干预措施包括,NSAIDs/COX-2抑制剂,全身类固醇,尾神经阻塞,局部甲基尼达,局部滴滴,局部糖酸盐,局部甘三酸盐和肉毒素注射.
结论:
- 之前的建议已经更新,主张局部用美特罗尼达,迪尔提亚泽姆,苏克拉酸盐和甘三酸盐,而不是口服的美特罗尼达.
- 双边布登达神经阻断被证实是有效的,而围内是不建议的.
- 毒素是一种可行的选择;手术方法的选择仍然取决于外科医生,切除手术被认为更痛苦.
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