PDF(Pubmed)
Abstract：
Nowadays, obstetrical anesthesia-related mortality is a very rare complication in industrialized countries. The recommended choice of intrathecal opioid for spinal anesthesia in the context of a multimodal peripartum pain management concept is discussed in this narrative review. Nowadays, there is a consensus that a perioperative multimodal pain concept should be used for caesarean delivery. This pain concept should include neuraxial opioids for spinal anesthesia, acetaminophen, NSAIDs, intravenous dexamethasone, and postoperative local or regional anesthetic procedures. Long-acting lipophobic opioids (diamorphine and morphine) have a significant analgesic advantage over short-acting lipophilic opioids (sufentanil and fentanyl). The risk of clinically relevant respiratory depression after neuraxial long-acting opioids is nowadays considered negligible, even if the data situation is weak in this regard. The question remains as to whether a pain concept that is ideally adapted to a neuraxial short-acting opioid shows benefit to a pain concept that is optimally adapted to neuraxial morphine. If long-acting opioids are used, the timing of each additional component of the multimodal analgesia strategy could ideally be adjusted to this longer duration of action.
摘要：
如今,在工业化国家,产科麻醉相关死亡率是一种非常罕见的并发症.本叙述性综述讨论了在多模式围产期疼痛管理概念的背景下，鞘内阿片类药物用于脊髓麻醉的推荐选择。如今,人们一致认为,围手术期多模式疼痛概念应用于剖腹产.这种疼痛概念应该包括用于脊髓麻醉的神经轴阿片类药物，对乙酰氨基酚,NSAIDs,静脉注射地塞米松，和术后局部或区域麻醉程序。长效疏脂性阿片类药物（二吗啡和吗啡）比短效亲脂性阿片类药物（舒芬太尼和芬太尼）具有明显的镇痛优势。如今，神经轴长效阿片类药物治疗后临床相关呼吸抑制的风险被认为可以忽略不计，即使数据情况在这方面很弱。仍然存在的问题是，理想地适应于神经轴短效阿片类药物的疼痛概念是否对最佳地适应于神经轴吗啡的疼痛概念显示出益处。如果使用长效阿片类药物，理想情况下,多模式镇痛策略中每个额外组分的时间都可以根据更长的作用时间进行调整.
