镇痛药物在神经外科术后疼痛管理中的应用

摘 要镇痛治疗是围手术期管理的重要环节，但目前尚无神经外科术后镇痛的标准方案。强阿片受体激动药可导致瞳孔缩小、呼吸抑制及颅压升高等，在神经外科患者中应用受限。弱阿片受体激动药可待因为优选方案，但也可能因代谢差异导致镇痛不足。曲马多、地佐辛、对乙酰氨基酚、非甾体抗炎药及其他辅助镇痛药物各有利弊。本文整理、分析并总结相关研究报道，详细阐述全身镇痛药物与局部麻醉镇痛在神经外科术后应用的特点，促进镇痛药物的合理应用。

Application of Analgesic Drugs in the Pain Management after Neurosurgery

ABSTRACT Analgesic treatment is an important part of perioperative management. There is no standard analgesic regimen after neurosurgery. Strong opioid receptor agonists are limited in neurosurgical patients due to miosis, respiratory depression and increased intracranial pressure. Codeine, a weak opioid receptor agonist, is the preferred regimen; however, some patients have inadequate analgesia due to metabolic differences. Tramadol, dezocine, acetaminophen, non steroidal anti inflammatory drugs and the other adjuvant analgesics have their own advantages and disadvantages. The clinical studies on postoperative analgesic treatment of neurosurgery were collected, analyzed and summarized in the paper. The characteristics of general and local analgesic drugs in neurosurgery were described, which could promote the rational use of analgesics.