圍術期之止痛方試不應只有嗎啡類藥物——使用多模式止痛可改善疼痛控制、減少併發症、進而促進術後快速恢復

Perioperative Pain Management is Not Just Opioid Treatment Alone-Using Multiple Strategies to Improve Pain Control, Reduce Complications, and Enhanced Outcomes

Multimodal analgesia (MMA) combines analgesics of multiple classes acting on distinct target sites through different strategies, including non-opiate analgesics (NSAIDs, acetaminophen, COX-2 inhibitors), α-2 agonists, epidural analgesia, local infiltration of analgesics, continuous peripheral nerve blockade, and so on. MMA improves postoperative pain control, subsequently improves patients’ satisfaction and quality of recovery. It also reduces opioid requirements, hence reduces many opioid-related adverse effects, such as constipation, PONV, sedation and respiratory depression. According to these benefits, MMA is currently the recommended practice in most fast-track clinical care plans, and all Enhanced Recovery After Surgery (ERAS) guidelines advocate MMA as perioperative pain management whenever possible. 多模式止痛包含了許多不同類型的止痛藥物，如非類固醇類消炎止痛藥、乙醯胺酚、α2腎上腺受體致效劑等；以及許多不同種類型的麻醉止痛方式，如硬膜外止痛、局部麻醉藥浸潤、連續性神經阻斷等。多模式止痛可以有效改善病人術後的疼痛情形，進而增加病人對於術後恢復的速度及滿意度。另外，由於多模式止痛可以減少病人對於嗎啡類止痛藥的使用量，因此可有效減少嗎啡類止痛藥常見之副作用，如便秘、噁心嘔吐、呼吸抑制等等。基於以上種種優點，多模式止痛已普遍被各種「術後快速恢復」的流程中採用，並在現行的所有「術後快速恢復」之準則規範中被明確地建議。