硬膜外麻醉和納疼解在手術後慢性疼痛之角色

The Role of Epidural Anesthesia Plus Ultrasound-Guided Peripheral Nerve Block and Naldebain in Chronic Post-Surgical Pain

手術後慢性疼痛（CPSP）是病人接受手術後所引發的慢性疼痛，影響病人生活品質甚劇， CPSP形成的原因非常多且複雜，而且臨床上也不易治療，不過在手術過程中就開始進行止痛，可以預防CPSP的發生。CPSP處置和預防的方式可以使用藥物，比如，嗎啡類，非類固醇抗發炎藥物（NSAIDs），抗癲癇藥物，以及手術部位注射局部麻醉劑注射。治療CPSP時，多模式鎮止痛multimodal analgesia可以減少鴉片類藥物的使用，及鴉片類藥物相關的副作用，而有效的預防性止痛，就需於手術前，並持續於術中到術後組織傷害復原為止，才能提供有效的抑制中樞疼痛神經之敏感化。近年來，也有人使用脊椎醉合併超音波導引神經阻斷術進行術中麻醉止痛及術後止痛。另外，新的長效止痛劑納疼解於術前給予，可以提供長達5至6天的術後止痛藥效。本期的台灣麻醉學雜誌中，也介紹了使用超音波導引神經阻斷合併硬脊膜外麻醉，使得術中麻醉，術後止痛都達到極高的滿意度。持續的手術中止痛可以有效預防CPSP。本篇回顧探討超音波引導神經阻斷，以及納疼解在CPSP的角色。

Chronic post-surgical pain (CPSP) is a chronic pain condition that reduces quality of life. The mechanisms of CPSP are complex, and pain management is limited. In particular, perioperative pain management is crucial to ensure long-term pain relief and CPSP prevention. The management and prevention of CPSP involves pharmacological treatment with opioids, acetaminophen, N-methyl-D-aspartate receptor antagonists, anticonvulsants, and local anesthesia. These treatments may be delivered via various routes, but all can provide better postoperative analgesia, with opioid-sparing effects and fewer opioid-related adverse effects, thus, preventing CPSP. Recently, ultrasoundguided peripheral nerve blocks have been widely used for regional anesthesia and postoperative analgesia. A newly lunched continuously released opioid naldebain can provide a long-term perioperative preventive pain inhibition. The present issue of the Taiwan Journal of Pain (TJP), a case report involving the use of ultrasound-guided peripheral nerve block and epidural anesthesia, this combination provided satisfactory anesthesia and postoperative pain relief. Continuous preventive perioperative analgesia is crucial for improving the quality of postoperative pain management, thus, attenuating or even preventing CPSP. This review discusses the role of combination of epidural anesthesia, ultrasound-guided peripheral nerve block plus naldebain in CPSP.