Thoracic Epidural Analgesia and Acute Pain （胸硬膜外镇痛和剧烈的疼痛）.pdfVIP

CLINICAL CONCEPTS AND COMMENTARY Bruno Riou, M.D., Ph.D., Editor Thoracic Epidural Analgesia and Acute Pain Management Smith C. Manion, M.D.,* Timothy J. Brennan, Ph.D., M.D.† AIN continues to be a significant problem for many tures.1 TEA is warranted when a moderate-to-large thoracic P patients after major surgery. In addition to improving or upper abdominal incision is anticipated. TEA can also be patient satisfaction and decreasing pain scores, enhanced a useful adjunct in fast-track surgery by optimizing pain re- perioperative pain control can improve clinical outcomes. lief, attenuating the surgical stress response, and allowing Thoracic epidural analgesia (TEA) remains a critical tool for early mobilization. TEA using local anesthetic is an impor- anesthesiologists to use in acute pain management. TEA is tant component of fast-track colorectal procedures because it particularly effective for reducing pain after thoracic and up- reduces the duration of postoperative ileus.2 Table 1 provides per abdominal surgery and likely permits major surgical pro- a comprehensive list of open surgical procedures in which cedures to be performed on patients with moderate to severe TEA can be used to treat postoperative pain. No unique comorbid diseases, who several years ago may have been de- contraindication to TEA exists that does not apply to all termined to be too great a risk for surgery. neuraxial procedures. In the past 10 yr, peripheral nerve blockade has improved Few large studies have evaluated the role of TEA in mini- perioperative analgesia for patients undergoing extremity mally invasive surgeries such a lapar