Anaesthesia and Intensive Care Medicine最新文献

英文中文

Implantable technology for pain management 疼痛管理的植入式技术

IF 0.2 Q4 ANESTHESIOLOGY

Anaesthesia and Intensive Care Medicine

Pub Date : 2025-05-30 DOI: 10.1016/j.mpaic.2025.04.002

G Baranidharan, Naresh Rajasekar

Neuropathic pain is a well-recognized chronic pain condition. This can have a significant impact on patients’ quality of life. Neuromodulation is defined by the International Neuromodulation Society as ‘the therapeutic alteration of activity in the central or peripheral nervous system either electrically or pharmacologically’. Electrical stimulation can be performed at the motor cortex, deep brain, spinal cord, dorsal root ganglion, peripheral nerve and peripheral nerve field. Pharmacological modulation is achieved by directly infusing drugs to the central nervous system. Although neuromodulation has become increasing popular, it is still currently believed to be underused in treating neuropathic pain. This modality has provided us with a non-pharmacological approach to manage patients with neuropathic pain. Patients should have been assessed by a multidisciplinary team before undergoing neuromodulation. This review highlights the present and future management of patients with chronic intractable pain using neuromodulation.

神经性疼痛是一种公认的慢性疼痛。这可能对患者的生活质量产生重大影响。国际神经调节学会将神经调节定义为“通过电或药理学对中枢或周围神经系统的活动进行治疗性改变”。电刺激可在运动皮层、脑深部、脊髓、背根神经节、周围神经和周围神经场进行。药理学调节是通过直接向中枢神经系统注入药物来实现的。尽管神经调节已经变得越来越流行，但目前仍认为它在治疗神经性疼痛方面的应用不足。这种方式为我们提供了一种非药物治疗神经性疼痛的方法。患者在接受神经调节前应由多学科小组进行评估。这篇综述强调了目前和未来使用神经调节治疗慢性难治性疼痛的患者。

引用次数: 0

Self-assessment 自我评估

IF 0.2 Q4 ANESTHESIOLOGY

Anaesthesia and Intensive Care Medicine

Pub Date : 2025-05-29 DOI: 10.1016/j.mpaic.2025.05.001

Vijayanand Nadella

引用次数: 0

Paediatric chronic pain 小儿慢性疼痛

IF 0.2 Q4 ANESTHESIOLOGY

Anaesthesia and Intensive Care Medicine

Pub Date : 2025-05-23 DOI: 10.1016/j.mpaic.2025.04.013

William Shankey-Smith

Chronic pain in children significantly impacts their physical, emotional, and social well-being, making its management complex and multifaceted. This review explores the intricacies of paediatric chronic pain, focusing on its prevalence, physiology, pathophysiology, assessment, and multidisciplinary management strategies. It discusses the development of pain pathways in children and highlights the mechanisms underlying peripheral and central sensitization in the development of chronic pain. Emphasis is placed on a comprehensive assessment approach using the biopsychosocial model, including history taking, physical examination, and age-appropriate pain assessment tools. This article also explores various management strategies, including pharmacological, physical, and psychological therapies. It emphasizes the importance of pain education and self-management techniques in empowering patients and families. By adopting a holistic approach that integrates biological, psychological, and social factors, healthcare professionals can optimize the quality of life and function of children living with chronic pain. This article aims to provide anaesthetists and pain specialists with a thorough understanding of paediatric chronic pain and effective management strategies to improve patient outcomes.

儿童慢性疼痛显著影响他们的身体、情感和社会福祉，使其管理复杂且多方面。这篇综述探讨了儿科慢性疼痛的复杂性，重点是其患病率、生理学、病理生理学、评估和多学科管理策略。它讨论了儿童疼痛通路的发展，并强调了慢性疼痛发展中外周和中枢致敏的机制。重点放在使用生物心理社会模型的综合评估方法上，包括病史记录、体格检查和适合年龄的疼痛评估工具。本文还探讨了各种管理策略，包括药理学，物理和心理治疗。它强调了疼痛教育和自我管理技术在赋予患者和家属权力方面的重要性。通过采用综合生物、心理和社会因素的整体方法，医疗保健专业人员可以优化患有慢性疼痛的儿童的生活质量和功能。本文旨在为麻醉师和疼痛专家提供对儿科慢性疼痛的全面了解和有效的管理策略，以改善患者的预后。

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引用次数: 0

Complex neuropathic pain states 复杂的神经性疼痛状态

IF 0.2 Q4 ANESTHESIOLOGY

Anaesthesia and Intensive Care Medicine

Pub Date : 2025-05-21 DOI: 10.1016/j.mpaic.2025.04.004

Claire Young, Daniel Govenden

The article provides an overview of complex neuropathic pain conditions, their underlying mechanisms and management including post-herpetic neuralgia, painful diabetic polyneuropathy, trigeminal neuralgia, complex regional pain syndrome, HIV related, post-surgical, and phantom limb pains.

本文概述了复杂的神经性疼痛条件，其潜在的机制和管理，包括疱疹后神经痛，疼痛性糖尿病多发性神经病变，三叉神经痛，复杂区域疼痛综合征，艾滋病相关，术后和幻肢痛。

引用次数: 0

Delivering an acute pain service 提供急性疼痛服务

IF 0.2 Q4 ANESTHESIOLOGY

Anaesthesia and Intensive Care Medicine

Pub Date : 2025-05-20 DOI: 10.1016/j.mpaic.2025.04.012

E Baird, B Patrick

Traditionally it has been the inpatient pain team's role to treat patients in hospital during an acute admission. The remit of the inpatient pain team is now extending to the whole patient's journey including surgical patients pre operatively and post discharge. The treatment of a patient's pain is primarily an ethical and humanitarian obligation, but effective pain management may also improve clinical outcomes. The treatment of pain from surgery or trauma reduces complication rates for example by improving mobilization and a patient's ability to take deep breaths and cough. When patients mobilize early they reduce their risk of venous thromboembolism, pulmonary embolism and pressure sores. A patient that cannot adequately cough or take deep breaths due to pain is at higher risk of pneumonia and respiratory compromise. From a health economics perspective patients who mobilize earlier and have fewer complications spend less time in hospital and therefore cost less. Untreated severe pain may also predispose patients to develop chronic pain or to take opioid pain medication for prolonged periods of time.

传统上，在急性住院期间治疗病人一直是住院疼痛小组的角色。住院病人疼痛小组的职权范围现在扩展到整个病人的旅程，包括手术病人术前和出院后。治疗病人的疼痛主要是一种道德和人道主义义务，但有效的疼痛管理也可以改善临床结果。手术或创伤引起的疼痛的治疗可以减少并发症的发生率，例如通过改善活动能力和患者深呼吸和咳嗽的能力。当患者早期活动时，他们降低了静脉血栓栓塞、肺栓塞和压疮的风险。因疼痛而不能充分咳嗽或深呼吸的患者患肺炎和呼吸系统疾病的风险较高。从卫生经济学的角度来看，更早动员和并发症更少的患者在医院的时间更短，因此费用更低。未经治疗的严重疼痛也可能使患者易患慢性疼痛或长时间服用阿片类止痛药。

引用次数: 0

Neuroablative interventions for cancer-related pain 癌症相关疼痛的神经消融干预

IF 0.2 Q4 ANESTHESIOLOGY

Anaesthesia and Intensive Care Medicine

Pub Date : 2025-05-15 DOI: 10.1016/j.mpaic.2025.04.005

Hemkumar Pushparaj, Manish Gupta, Manohar L. Sharma

Cancer treatment continues to improve survival rate in cancer patients. This also increases cancer-related pain prevalence. Thus, with advances in cancer treatment, there is an ever-increasing unmet need in cancer pain management. Opioids and adjuvant pain killers help to manage significant numbers. Still significant numbers suffer from intractable treatment resistant pain and thus need other modalities. Neuroablative techniques, although technically more demanding, provide good pain control especially in these patients with limited prognosis. Neuroablative procedures are indicated in cancer patients who have limited life expectancy with severe, opioid-resistant pain. The goal would be to improve the quality of life, reduce analgesic side effects, improve patients’ ability to function, socialize, and to reduce the amount of time spent in contact with healthcare providers. When successful, these interventions allow significant reduction in the need for clinic visits. Percutaneous procedures are preferred over open procedures for their lower morbidity. This review provides a brief description of commonly used neurolytic interventions for cancer-related pain in our multidisciplinary set-up. Neuroablative procedures, especially percutaneous cervical cordotomy, require considerable skill of the physician performing the procedure.

癌症治疗不断提高癌症患者的生存率。这也增加了癌症相关疼痛的发病率。因此，随着癌症治疗的进步，在癌症疼痛管理方面的需求不断增加。阿片类药物和辅助止痛药有助于控制大量患者。仍然有相当多的人患有顽固性疼痛，因此需要其他治疗方式。神经消融技术，虽然技术要求更高，提供良好的疼痛控制，特别是在这些患者的预后有限。神经消融手术适用于预期寿命有限并伴有严重阿片类药物耐受性疼痛的癌症患者。其目标是提高生活质量，减少镇痛副作用，提高患者的功能、社交能力，并减少与医疗保健提供者接触的时间。如果成功，这些干预措施可以显著减少门诊就诊的需要。由于其发病率较低，经皮手术优于开放手术。这篇综述提供了在我们的多学科设置中常用的神经溶解干预癌症相关疼痛的简要描述。神经切除手术，特别是经皮颈椎脊髓切开术，要求医师有相当的手术技巧。

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引用次数: 0

Visceral pain 发自内心的痛苦

IF 0.2 Q4 ANESTHESIOLOGY

Anaesthesia and Intensive Care Medicine

Pub Date : 2025-05-15 DOI: 10.1016/j.mpaic.2025.04.001

Iain Mactier, Tammar Al-Ani

Visceral pain is a complex and multifaceted experience, distinct from somatic pain due to its diffuse localisation, autonomic involvement, and strong affective components. It arises from internal organs and follows unique neurophysiological pathways, encompassing transduction, transmission, perception, modulation, and amplification. Visceral nociception is transmitted via autonomic afferents and ascends through the spinothalamic, spinoreticular, spinomesencephalic, and dorsal column pathways. The extensive convergence of visceral and somatic afferents contributes to referred pain and poses diagnostic challenges. Acute visceral pain is primarily nociceptive, triggered by inflammation, ischaemia, or distension, whereas chronic visceral pain involves central sensitisation, dysfunction of descending modulation, and neuroimmune activation, leading to persistent pain and visceral hypersensitivity. While simple analgesics, opioids, and regional anaesthesia techniques incorporating sympathetic blockade remain cornerstones of acute visceral pain treatment, chronic visceral pain management is more complex. It relies on a multidisciplinary approach, integrating pharmacotherapy, interventional techniques, physiotherapy, psychotherapy, lifestyle modifications, and patient education to support self-management, improve symptom control, and enhance function and quality of life.

内脏疼痛是一种复杂的、多方面的体验，不同于躯体疼痛，因为它的弥漫性定位、自主神经参与和强烈的情感成分。它起源于内脏，遵循独特的神经生理途径，包括转导、传递、感知、调节和放大。内脏伤害感觉通过自主神经传入，并通过丘脑、神经网状、脑脊髓和背柱通路上升。内脏和躯体传入的广泛收敛有助于转诊疼痛，并提出诊断挑战。急性内脏痛主要是伤害性的，由炎症、缺血或肿胀引起，而慢性内脏痛涉及中枢致敏、下行调节功能障碍和神经免疫激活，导致持续疼痛和内脏超敏反应。虽然简单的镇痛药、阿片类药物和结合交感阻滞的局部麻醉技术仍然是急性内脏痛治疗的基础，但慢性内脏痛的治疗更为复杂。它依靠多学科方法，整合药物治疗、介入技术、物理治疗、心理治疗、生活方式改变和患者教育，以支持自我管理，改善症状控制，增强功能和生活质量。

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引用次数: 0

Radiofrequency techniques in chronic pain management 射频技术在慢性疼痛管理中的应用

IF 0.2 Q4 ANESTHESIOLOGY

Anaesthesia and Intensive Care Medicine

Pub Date : 2025-05-14 DOI: 10.1016/j.mpaic.2025.04.006

Peter Paisley, Anne Devine

Radiofrequency ablation is the use of radio waves to create a thermal lesion or isotherm. This process can be used to treat a variety of chronic pain conditions such as facet joint pain, shoulder and knee pain, and trigeminal neuralgia, by targeting the responsible sensory nerve and disrupting pain transmission. It can be performed by continuous, pulsed or cooled application. The technique is performed under fluoroscopy or ultrasound guidance to identify the correct target before the current is applied, making it a minimally invasive procedure that is well tolerated. In appropriately selected candidates it can significantly improve pain, function and result in a better quality of life.

射频消融是利用无线电波产生热损伤或等温线。该过程可用于治疗各种慢性疼痛状况，如小关节疼痛，肩膝疼痛和三叉神经痛，通过靶向负责的感觉神经和破坏疼痛传递。它可以通过连续，脉冲或冷却应用来执行。该技术在透视或超声引导下进行，在施加电流之前确定正确的目标，使其成为一种微创手术，耐受性良好。在适当选择的候选人，它可以显著改善疼痛，功能，并导致更好的生活质量。

引用次数: 0

Challenges in healthcare delivery in low- and middle-income countries 低收入和中等收入国家卫生保健服务面临的挑战

IF 0.2 Q4 ANESTHESIOLOGY

Anaesthesia and Intensive Care Medicine

Pub Date : 2025-05-14 DOI: 10.1016/j.mpaic.2025.02.010

Hannah Phelan, Victoria Yates, Emma Lillie

The Lancet Commission outlines a vision of universal access to safe emergency and essential surgery. Global disparities in perioperative outcomes are recognized, with resource-poor environments and a workforce crisis particularly challenging low- and middle-income countries (LMICs) to provide safe surgical and anaesthesia care. The coronavirus disease (COVID-19) pandemic placed an even greater strain on under-resourced and over-stretched healthcare systems. Bridging the gap to achieve universal access is a substantial undertaking and requires collaboration with high-income countries. Global partnerships are abundant and mutually beneficial, aiming to alleviate the workforce crisis, provide education, training and expertise and raise standards of care in host LMICs. Clinical, leadership and management experience gained in low-resource settings is valued by healthcare systems in high-income countries, acknowledged by curriculum for ‘developing world anaesthesia’. Further challenges to healthcare delivery, training and implementation of change are influence by government policy, cultural traditions, expectations and work ethic. During the COVID-19 pandemic many partnerships were required to move online. The necessity of providing remote support has created its own set of challenges, while also providing novel opportunities for education and collaboration with the global health community. This article describes challenges through reflection on personal experience in Zambia.

《柳叶刀》委员会概述了普遍获得安全急诊和基本手术的愿景。人们认识到全球围手术期结果的差异，资源贫乏的环境和劳动力危机对低收入和中等收入国家（LMICs）提供安全的手术和麻醉护理尤其具有挑战性。冠状病毒病（COVID-19）大流行给资源不足和过度紧张的医疗保健系统带来了更大的压力。弥合差距以实现普遍可及是一项艰巨的任务，需要与高收入国家合作。全球伙伴关系丰富且互利，旨在缓解劳动力危机，提供教育、培训和专业知识，并提高东道国中低收入国家的护理标准。高收入国家的卫生保健系统重视在低资源环境中获得的临床、领导和管理经验，“发展中国家麻醉”课程也承认这一点。政府政策、文化传统、期望和职业道德对医疗保健服务、培训和变革实施的进一步挑战。在2019冠状病毒病大流行期间，许多伙伴关系被要求转移到网上。提供远程支助的必要性带来了一系列挑战，同时也为教育和与全球卫生界的合作提供了新的机会。这篇文章通过反思在赞比亚的个人经历来描述挑战。

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引用次数: 0

Obstetric haemorrhage 产科出血

IF 0.2 Q4 ANESTHESIOLOGY

Anaesthesia and Intensive Care Medicine

Pub Date : 2025-05-14 DOI: 10.1016/j.mpaic.2025.02.016

Sarah Lambert, Louise England

Obstetric haemorrhage is a major cause of maternal morbidity and mortality globally. Identifying risk factors, implementing early risk stratification, and engaging in multidisciplinary team planning can help mitigate its impact. Effective haemorrhage management requires prompt recognition and a rapid, coordinated, multidisciplinary approach. The use of protocols reinforced through targeted drills enhances team vigilance, familiarity, and competency in managing haemorrhage which can lead to improved patient outcomes. This article reviews the management of obstetric haemorrhage including pharmacological interventions, transfusion strategies and surgical techniques.

产科出血是全球孕产妇发病和死亡的一个主要原因。识别风险因素，实施早期风险分层，参与多学科团队计划可以帮助减轻其影响。有效的出血管理需要及时识别和快速、协调、多学科的方法。通过有针对性的演练加强方案的使用，可以提高团队的警惕性、熟悉度和管理出血的能力，从而改善患者的预后。本文回顾了产科出血的管理，包括药物干预，输血策略和手术技术。

引用次数: 0

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全部 ACS Publications Elsevier ieeexplore Springer The Royal Society of Chemistry Wiley

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Anaesthesia and Intensive Care Medicine

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