美国药物输送和治疗杂志 开放获取

抽象的

確保圍手術期和 PACU 藥物安全

公元約翰

術後急性疼痛仍然是一個重要問題，如果控制不充分，會帶來不同的不幸結果。大多數細心的患者術後都會在麻醉後監護室 (PACU) 中度過，在那裡折磨管理人員，不准入院並需要升級，影響進一步的康復。 PACU 委員會對術後疼痛進行了後期調查，以了解評估和藥物方面的進展。越來越多的目標評估獨立於患者的投入可能適合 PACU，包括光電體積描記法推斷的邊界、無疼痛傷害感受表、皮膚電導和瞳孔測量，儘管預計進一步的檢查將證實它們的效用。各種鎮痛藥和方法的多模式無痛已被廣泛使用。在預防焦點銳利化的假設前提下，預防性疼痛逐漸消失是正常的。新的麻醉劑正在被創造，以盡量減少傳統麻醉劑的不利影響。越來越多的靜脈非鴉片類鎮痛藥和輔助藥物（例如右美托咪定和地塞米松）因其節省麻醉藥的效果而被提出。目前的證據表明，省級疼痛緩解策略在減少疼痛方面取得了成功，並保留在 PACU 中。與硬膜外疼痛相比，神經周圍方法和浸潤策略（包括傷口侵入、腹橫肌平面方形、局部無痛穿透和腹膜內組織）的可及性選擇在其可行性和安全性方面發揮著越來越重要的作用。

The Lancet Commission on Global Surgery, Global Surgery 2030, around 30% of the worldwide weight of ailment can be credited to precisely treatable conditions, and the job of careful and sedation care in improving the strength of people and the monetary profitability of nations has stimulated the consideration of World Health Organization (WHO). An extreme objective of careful treatment is moving toward better recuperation for a high caliber of existence without confusions and sequelaes. Over 80% of careful patients experience postoperative torment, the undertreatment of which brings about an assortment of negative outcomes and stays an impressive issue around the world. Tireless postsurgical torment (PPP), the rate of which being up to 30–half, beginning from careful mediation and intense postoperative agony without sufficient administration, has significant adverse impacts on the person's personal satisfaction and spots an overwhelming weight to the general public upsetting a great many individuals all inclusive and difficulties for perioperative doctors. The seriousness of postoperative agony has been proposed as a key hazard factor of PPP, and sufficient absense of pain for intense torment during the early postsurgical period might be related with less occurrence of PPP. Postanesthesia care unit (PACU) ranges the change from medical procedure space to wards, and most patients spend the initial scarcely any hours after medical procedure, their prompt postoperative period, in the PACU. Satisfactory agony the board in the PACU is an essential piece of forestalling PPP. We inspected the ongoing investigations for the advances in evaluations and medicines for postoperative torment in the PACU.

It was indicated that 41% of patients in the PACU detailed moderate or serious pain. Most of the patients in the PACU are portrayed with various physiological aggravations brought about by rising up out of sedation and medical procedure, which influence numerous organs and frameworks. Postoperative agony and following fomentation for the most part add dangers and weakening to inconveniences with their collaborations, disturbing results. As per the rules by the American Society of Anesthesiologists, routine appraisal and observing of agony identifies entanglements and diminishes unfriendly results, which ought to be performed during development and recovery. However, obviousness or potentially ineptitudes of clear verbal articulation acquire more challenges evaluation and treatment for torment in the PACU.

為了更好的治療和管理，應該準確、及時地評估疼痛，這對 PACU 中的患者提出了挑戰。雖然疼痛的距離應包括其範圍、開始、性質、加重和緩解因素等，但測量疼痛的強度並記錄主要緩解疼痛的時間是逐漸常識，衡量疼痛的標準是：鎮痛藥、治療的影響和不友善的影響、患者反應所顯示的疼痛緩解系統的調整以及他們在PACU 中的履行。心理因素影響折磨明辨；因此，應該考慮精神狀態，特別是對於那些有精神問題歷史背景的人。區分存在的不安、憂鬱、神經質等，可能會鼓勵對折磨的評估。

調查折磨力的策略很多，包括旁觀量表和自我報告量表。由於折磨主要是一種抽象的觀察，因此自我宣布評估仍然是患者意識、準確理解和言語行為的最高品質水平，包括視覺模擬量表（VAS）、數字評定量表（NRS）、言語評定量表（VRS） ，和 Wong-Baker 臉部疼痛評定量表，儘管標準技術仍然是討論的主題。由於鎮靜或鎮靜未完全恢復，抽象技術的後遺症可能會受到 PACU 中患者短暫狀態的干擾（例如安靜、基本疾病、智力障礙或在表達方面遇到問題）。這樣，在 PACU 中對疼痛和無疼痛的目標評估將具有重要意義。

關注病灶銳化，預防性消除疼痛可能有助於減少強烈和持續的術後疼痛的發生和嚴重性。作為預防性止痛的一部分，先發性止痛包括術前組織鎮痛藥，目的是使它們在手術中有效，在出現痛苦刺激之前阻止病灶銳化。預防性無痛包括透過阻斷所有有毒圍手術期升級的神經傳遞，在整個圍手術期採用更廣泛的方法。儘管受到導致模棱兩可的方法問題的限制，先發製人地消除疼痛的功效已得到維護並且更普遍地被接受。具體來說，所有適合術後止痛的圍手術期藥物，包括預防性止痛，都可以被視為PACU中術後疼痛板的一部分。