术后镇痛理念新跨越：从超前镇痛到预防性镇痛

术后急性疼痛可以转变成慢性疼痛，通过预防性镇痛的手段可以减少术后慢性疼痛的发生。预防性镇痛的概念是在超前镇痛的基础上发展起来的，是指在超过药物作用持续的时间之后，仍然能观察到疼痛减轻和/或镇痛药用量减少的现象。超前镇痛强调镇痛的时机，而预防性镇痛则强调镇痛的质量和持续时间，其目的是减轻或消除围术期有害刺激造成的中枢敏化。有研究证明区域阻滞麻醉、钙离子通道调节剂普瑞巴林、NMDA受体阻断剂氯胺酮等都具有预防性镇痛作用。术后急性疼痛和术后远期慢性疼痛之间的联系及其发生机制以及急性阿片耐受和痛觉过敏的机制还有待进一步研究。

Postoperative analgesia concept update: from preemptive analgesia to preventive analgesia

There is a possibility that postoperative acute pain can transit to pain chronicity. It can be blocked by preventive analgesia. The concept of preventive analgesia, which means the analgesic effect is observed at a point in time that exceeds the clinical duration of action of the target drug, is developed from pre-emptive analgesia. The focus of preventive analgesia is not necessarily on the relative timing of analgesic or anesthetic interventions, but on attenuating the impact of noxious perioperative stimuli that induce peripheral and central sensitization. Studies have shown preventive analgesia effect was observed in regional anesthesia, with calcium channel modulator pregabalin and N-methyl-D-aspartate receptor antagonist ketamine. One of the aims of future research is to identify the relationship between postoperative acute pain and persistent pain and the mechanism of acute opioid tolerance and opioid-induced hyperalgesia.