适当的术后镇痛可提高患者的活动能力,减少并发症发生率,并改善患者满意度,同时还能缩短住院时间和相应费用.早期的术后镇痛主要依赖于患者疼痛时给予的阿片类药物,近年来多模式镇痛(multimodal analgesia,MMA)方案发展迅速,能够显著减少阿片类药物的使用和相关不良反应.脊柱手术中的MMA主要包括超前镇痛、非甾体抗炎药、神经调节药物、对乙酰氨基酚类药物、椎管内阻滞和局部扩大麻醉等.目前研究表明选择性非甾体抗炎药或短期、低剂量非选择性非甾体抗炎药不会影响脊柱术后融合率;而神经调节剂能够缓解患者疼痛并减少阿片类药物使用,且无明显的不良反应;对乙酰氨基酚是脊柱术后不同镇痛方案的基础;此外,Ⅰ级证据表明在腰椎间盘切除术后椎管内阻滞能够改善患者短期疼痛和神经系统症状;还有部分研究认为局部扩大麻醉能够减少脊柱手术术后其他镇痛药物的使用.越来越多的证据支持使用超前MMA方案控制脊柱手术患者的术后疼痛,但尚需进一步的高质量研究以确定MMA方案的最佳药剂、剂量和时间,并进一步阐明对脊柱手术预后的影响.%Optical postoperative analgesia can improve patient mobility, reduce the incidence of complications, and im?prove patient satisfaction, while reducing hospital stays and costs. Early postoperative analgesia mainly depends on the opioids. In recent years, multimodal analgesia (MMA) program has been developed rapidly, which can significantly reduce the use of opioids and related adverse reactions. MMA in spinal surgery mainly includes advanced analgesia, non?steroidal anti?inflammatory drugs, neuromodulation drugs, acetaminophen drugs, intrathecal block and local expanded anesthesia. Current studies show that selective non?steroidal anti?inflammatory drugs or short?term, low?dose non?selective non?steroidal anti?inflammatory drugs do not affect postoperative spinal fusion; Neuromodulators can alleviate pain and reduce opioid use, while without significant adverse effects;Acetaminophen is the basis for different analgesia regimens after spinal surgery; In addition, level I evidence suggests that intrathe?cal block after lumbar discectomy can improve short?term pain and neurological symptoms of patients; Some studies suggest that local expanded anesthesia can reduce the use of other analgesics after spinal surgery. A growing of evidence supports the use of ad?vanced MMA regimens to control postoperative pain in patients undergoing spinal surgery, but further high?quality studies are needed to determine the optimal agent, dose, and timing of the MMA regimen, and to further elucidate the impact on spinal surgery outcomes.
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