2025年开放胸切除术后的疼痛管理:程序特定的术后疼痛管理 (PROSPECT) 建议
Adrien Lemoine1, Anna Alber2, Girish P Joshi3
1Department of Anaesthesia, Intensive Care and Pain Management, Oscar Lambret Centre, Lille, France.
Anaesthesia
|January 12, 2026
概括
更新的指导方针建议胸部外周止痛或椎阻塞作为开放胸切除术后的第一线疼痛管理. 基本的全身止痛应该补充这些区域技术,以获得最佳的患者康复.
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:
- 有效的术后疼痛控制对于开放胸切除术后的康复至关重要.
- 此外,此次手术后对疼痛管理的先前建议需要更新.
研究的目的:
- 更新对开放胸切除术患者的手术后疼痛管理建议.
- 为治疗胸切除术后疼痛的临床医生提供基于证据的指导.
主要方法:
- 随机对照试验的系统审查,系统审查和元分析 (2015-2024年).
- 使用了PROSPECT方法和修改后的Delphi方法来完成建议.
- 使用柯克兰偏见风险工具评估证据质量 2.
主要成果:
- 推胸部外周止痛或副脊椎阻塞作为一线干预措施.
- 勃起脊柱平面,状肋间或肋间神经块被建议作为二线选择.
- 基本止痛包括和NSAIDs/COX-2抑制剂;在特定情况下,针/cryoanalgesia.
结论:
- 更新的指导方针优先考虑胸部外周止痛或副脊椎阻塞,根据患者/临床医生的偏好,结合全身止痛.
- 替代区域区块是为无法接受初级一线干预的患者保留的.
- 建议专注于手术技术,物理治疗和患者教育的非疼痛结果.
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