Consensus on the perioperative pain management of cancer patients in China (2020 edition)
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摘要: 肿瘤切除术是绝大多数早中期实体肿瘤治疗的基础，肿瘤切除术后常伴随持续的疼痛。手术创伤和疼痛可引起炎症、下丘脑-垂体轴激活和交感系统过度反应发生。这些因素会影响肿瘤患者的免疫能力，导致免疫抑制。围术期有效的疼痛管理可以优化肿瘤患者的免疫功能，对肿瘤患者术后康复也具有重要意义。因此，中国抗癌协会肿瘤麻醉与镇痛专业委员会组织专家制定我国肿瘤患者围术期疼痛管理的专家共识，目的是为肿瘤患者术后急性疼痛管理提供基于证据的临床建议。本共识为学术性建议，仅限于指导肿瘤患者术后急性疼痛管理，不适用慢性疼痛或肿瘤导致的癌性疼痛。Abstract: Surgical tumor excision is a cornerstone of primary cancer treatment, and persistent postoperative pain is common after most surgical procedures. Surgical trauma and pain can cause inflammation, hypothalamic-pituitary axis activation, and sympathetic system over-reactivity. These factors, acting either separately or in combination, affect anti-tumor immunity and promote postoperative immunosuppression. Effective management of perioperative pain may help to modulate the unwanted consequences of the stress response on the immune system and improve outcomes. Based on the recent literature and clinical studies, experts from The Society of Oncological Anesthesia and Analgesia, Chinese Anti-Cancer Association have developed this consensus on the perioperative pain management of cancer patients in China (2020 edition). This consensus aims to provide evidence-based clinical recommendations for the acute pain management of cancer patients postoperatively. It does not apply to chronic pain or pain caused by cancer.
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Key words:
- expert consensus /
- perioperative pain management /
- antitumor immunity /
- analgesic
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图 2 肿瘤患者围术期多模式镇痛管理
①氯胺酮；②加巴喷丁和普瑞巴林；③对乙酰氨基酚或NSAIDs；④阿片类药物；⑤外周神经阻滞和（或）局麻药切口浸润；⑥硬膜外局麻药复合阿片类药物PCEA；⑦其他（静注利多卡因、物理方式、认知行为模式）
表 1 疼痛评估方法
表 2 硬膜外镇痛药物和输注浓度
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