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首页> 外文期刊>Current opinion in anaesthesiology >From preemptive to preventive analgesia.
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From preemptive to preventive analgesia.

机译：从预防性镇痛到预防性镇痛。

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PURPOSE OF REVIEW: Much effort has been taken to prove that a treatment initiated before surgery is more effective in reducing postoperative pain compared with the same intervention started after surgery. Clinical studies failed to demonstrate major clinical benefits of preemptive analgesia, however, and the results of recent systemic reviews are equivocal. The present review will discuss recent clinical as well as experimental evidence of preemptive analgesia and examine the implications of a preventive postoperative pain treatment. RECENT FINDINGS: Recent preclinical and clinical studies give strong evidence that neuronal hypersensitivity and nociception after incision is mainly maintained by the afferent barrage of sensitized nociceptors across the perioperative period. This is in contrast to pain states of other origin in which prolonged hypersensitivity is initiated during the injury. Therefore, not timing but duration and efficacy of an analgesic and antihyperalgesic intervention are most important for treating pain and hyperalgesia after surgery. SUMMARY: Extending a multimodal analgesic treatment into the postoperative period to prevent postoperative pain may be superior compared with preemptive analgesia. In the future, appropriate drug combinations, drug concentrations and duration of preventive strategies need to be determined to be most beneficial for the management of acute and chronic pain after surgery.
机译：审查的目的：已做出大量努力来证明与在手术后开始的相同干预相比，在手术前开始的治疗在减轻术后疼痛方面更有效。临床研究未能证明先发性镇痛的主要临床益处，但是，最近的系统评价结果尚不清楚。本综述将讨论先发镇痛的最新临床和实验证据，并探讨预防性术后疼痛治疗的意义。最近的发现：最近的临床前和临床研究提供了有力的证据，表明切口后的神经元超敏反应和伤害感受主要是由围手术期敏锐的伤害感受器传入来维持的。这与其他来源的疼痛状态相反，在受伤状态下，这种状态会引起长时间的超敏反应。因此，对于外科手术后的疼痛和痛觉过敏，镇痛和抗痛觉过敏干预的时机而不是时机，而是持续时间和疗效最为重要。摘要：与先发性镇痛相比，将多模式镇痛治疗延长至术后可预防术后疼痛可能更好。将来，需要确定适当的药物组合，药物浓度和预防策略的持续时间，以最有利于手术后急性和慢性疼痛的治疗。

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