围术期镇痛幻灯片医学课件.ppt

紧邻术后阶段 （术后48h内） “逐步下降”，多模式途径 （自术后第3天） 背景： 对乙酰氨基酚+COX-2抑制剂 局部麻醉/封闭 根据疼痛强度可按需加用： 阿片类合并药 更强的阿片类药 基线 ：对乙酰氨基酚 + NSAID、COX-2抑制剂 + 短效PRN阿片类合并药 + 曲马多 + PRN口服吗啡作为救援疗法 中度 疼痛强度 重度 手术后疼痛控制 Thomas J.Schnitzer.Clin Rheumatol(2006)25(Suppl 1):S22-S29 * 运动/炎性疼痛 疼痛强度 中度 重度 √ NSAID/COX-2抑制剂 √ +/-短效弱阿片类/曲马多 √ +/-强阿片类 康复期疼痛控制 Thomas J.Schnitzer.Clin Rheumatol(2006)25(Suppl 1):S22-S29 * 250 patients who had undergone surgical procedures (in- and outpatient) in the past year completed a questionnaire about their experiences with pain before and after surgery. The most common concern that patients expressed prior to surgery was experiencing pain (59%), which was cited more often than concerns about whether the surgery would improve their condition (51%) or whether they would fully recover (46%). 58% of the sample reported pain prior to surgery. Despite receiving treatment for pain, 82% reported pain in the immediate postsurgical period (end of surgery up to 2 weeks after discharge) and 75% reported pain after discharge. More than two thirds of patients reported pain of moderate to severe intensity, and extreme pain was reported by 18% overall and 8% after discharge. Apfelbaum JL, Chen C, Mehta SS, Gan TJ. Postoperative pain experience: results from a national survey suggest postoperative pain continues to be undermanaged. Anesth Analg. 2003;97:534-540. 250 patients who had undergone surgical procedures (in- and outpatient) in the past year completed a questionnaire about their experiences with pain before and after surgery. The most common concern that patients expressed prior to surgery was experiencing pain (59%), which was cited more often than concerns about whether the surgery would improve their condition (51%) or whether they would fully recover (46%). 58% of the sample reported pain prior to surgery. Despite receiving treatment for pain, 82% reported pain in the immediate postsurgical period (end of surgery up to 2 weeks after discharge) and 75% reported pain after discharge. Mo