A guideline for postsurgical pain exists, created in the US in 2016, which includes the prevention of such pain. In this guideline, multimodal analgesia is recommended for the prevention of postsurgical pain (Figure 1). There are reports suggesting that multimodal analgesia increases the analgesic effect with a reduction of the total amount of opioid usage. According to the guideline, it is recommended to administrate opioids orally rather than intravenously whenever possible for the prevention of postsurgical pain. Also, opioid administration before surgery is not recommended, and if oral administration is not possible, administration by patient-controlled analgesia (PCA) is recommended. Furthermore, monitoring of the patient is necessary when administrating opioids, as adverse events concerning analgesia and respiratory function may occur. Concerning non-steroidal anti-inflammatory drugs (NSAIDs) and acetaminophen, multimodal use is recommended. NSAIDs cause analgesic effects by inhibiting cyclooxygenase, an enzyme responsible for producing prostaglandin, a pain-inducing eicosanoid. On the other hand, acetaminophen shows analgesic effects by inhibiting the ascending pain pathway at the central level and by activating the descending pain inhibitory system mediated by serotonin. Due to the differing mechanisms of analgesia, it is known that the combined administration of NSAIDs and acetaminophen increases the analgesic effect. However, both drugs have risks of developing complications. NSAIDs are known to be associated with increasing the risk of developing gastrointestinal bleeding, ulcers, cardiovascular events, and renal dysfunction. The over-administration of acetaminophen increases the risk of hepatic dysfunction. Concerning pregabalin and gabapentin, there are reports suggesting that by co-administrating these two drugs during the perioperative period, the amount of opioid usage after the operation is reduced, and postsurgical pain also reduces. The guideline also strongly recommends the use of the two drugs as part of multimodal analgesia.

美國(guó)于2016年制定了一項(xiàng)術(shù)后疼痛指南,，其中包括預(yù)防此類(lèi)疼痛,。在本指南中，建議使用多模式鎮(zhèn)痛來(lái)預(yù)防術(shù)后疼痛（圖1）,。有報(bào)告表明,，多模式鎮(zhèn)痛可增加鎮(zhèn)痛效果，減少阿片類(lèi)藥物的使用總量,。根據(jù)該指南,，建議盡可能口服阿片類(lèi)藥物，而不是靜脈注射,，以預(yù)防術(shù)后疼痛,。此外，不建議在手術(shù)前服用阿片類(lèi)藥物,，如果不可能口服,，建議通過(guò)患者自控鎮(zhèn)痛（PCA）給藥。此外,，在服用阿片類(lèi)藥物時(shí),，有必要對(duì)患者進(jìn)行監(jiān)測(cè)，因?yàn)榭赡軙?huì)發(fā)生與鎮(zhèn)痛和呼吸功能相關(guān)的不良事件,。關(guān)于非甾體抗炎藥（NSAIDs）和對(duì)乙酰氨基酚,，建議多模式使用。非甾體抗炎藥通過(guò)抑制環(huán)氧化酶（一種產(chǎn)生前列腺素的酶）產(chǎn)生鎮(zhèn)痛作用,，前列腺素是一種引起疼痛的二十碳五烯酸,。另一方面，對(duì)乙酰氨基酚通過(guò)抑制中樞水平的上行疼痛通路和激活由5-羥色胺介導(dǎo)的下行疼痛抑制系統(tǒng)而顯示出鎮(zhèn)痛作用,。由于鎮(zhèn)痛機(jī)制不同,，已知非甾體抗炎藥和對(duì)乙酰氨基酚的聯(lián)合用藥會(huì)增加鎮(zhèn)痛效果。然而,，這兩種藥物都有發(fā)生并發(fā)癥的風(fēng)險(xiǎn),。已知非甾體抗炎藥與增加胃腸道出血、潰瘍,、心血管事件和腎功能障礙的風(fēng)險(xiǎn)有關(guān),。過(guò)量服用醋氨酚會(huì)增加肝功能障礙的風(fēng)險(xiǎn),。關(guān)于普瑞巴林和加巴噴丁，有報(bào)道表明,，通過(guò)在圍手術(shù)期聯(lián)合使用這兩種藥物,，術(shù)后阿片類(lèi)藥物的用量減少，術(shù)后疼痛也減少,。該指南還強(qiáng)烈建議使用這兩種藥物作為多模式鎮(zhèn)痛的一部分,。

Furthermore, in a recent randomized controlled trial (RCT) study that compared the degree and complications of acute postsurgical pain, where 122 patients performing craniotomy were divided randomly into a gabapentin-administered group and a placebo group, a significant decrease in acute postsurgical pain score within 24 hours were seen in the gabapentin-administered group. The rate of developing postoperative nausea and vomiting (PONV) was also significantly lower for the gabapentin-administered group. It is also reported that the administration of dexmedetomidine, an analgesic drug that inhibits the pain pathway by acting on the α2A receptor of the spinal cord reduces postsurgical pain and thus becomes an option for the postsurgical analgesia method. Analgesia by regional anesthesia, such as epidural anesthesia, is also strongly recommended by the guideline. Studies have shown that, compared to the systemic administration of opioids, the combined use of epidural anesthesia reduces the amount of analgesia used for postsurgical rescue and lowers the postsurgical death rate. Epidural anesthesia reduces the development of postsurgical complications, such as deep venous thrombosis (DVT), pneumonia, atelectasis, respiratory suppression, atrial fibrillation (AF), and PONV, and it is suggested that performing regional anesthesia whenever possible would give benign consequences concerning postsurgical analgesia.

此外，在最近的一項(xiàng)比較急性術(shù)后疼痛程度和并發(fā)癥的隨機(jī)對(duì)照試驗(yàn)研究中,，122名開(kāi)顱手術(shù)患者被隨機(jī)分為加巴噴丁給藥組和安慰劑組,，結(jié)果加巴噴丁給藥組術(shù)后24小時(shí)內(nèi)急性疼痛評(píng)分明顯減少。加巴噴丁組術(shù)后惡心和嘔吐的發(fā)生率也明顯降低,。另?yè)?jù)報(bào)道,，右美托咪定是一種鎮(zhèn)痛藥物,，通過(guò)作用于脊髓的α2A受體來(lái)抑制疼痛通路,，從而減少術(shù)后疼痛，因此成為可供選擇的一種術(shù)后鎮(zhèn)痛方法,。指南還強(qiáng)烈建議采用區(qū)域麻醉,，如硬膜外麻醉進(jìn)行鎮(zhèn)痛。研究表明,，與全身應(yīng)用阿片類(lèi)藥物相比,，聯(lián)合使用硬膜外麻醉可減少術(shù)后所用的鎮(zhèn)痛藥物的總量，降低術(shù)后死亡率,。硬膜外麻醉可減少術(shù)后并發(fā)癥的發(fā)生,，如深靜脈血栓形成、肺炎,、肺不張,、呼吸抑制、心房顫動(dòng)和PONV,。建議可能的話,，術(shù)后鎮(zhèn)痛盡可能采用區(qū)域麻醉以達(dá)到更好的結(jié)局。