加速康复外科(ERAS)理念下腹部手术多模式镇痛的研究进展
Research Progress on Multimodal Analgesia for Abdominal Surgery under the Concept of Enhanced Recovery after Surgery (ERAS)
摘要: 腹部手术术后剧烈疼痛是阻碍患者快速康复的关键因素。在加速康复外科(ERAS)理念指导下，多模式镇痛(MMA)已从经验性治疗转变为围术期的核心路径，旨在通过协同作用最大限度减少阿片类药物用量及其不良反应。本文系统综述了腹部手术MMA的最新研究进展，重点阐述了以非甾体抗炎药为基础、联合静脉输注(如利多卡因)及新型区域阻滞(如腹横肌平面阻滞替代传统硬膜外麻醉)的“低阿片化”策略。现有循证医学证据表明，规范实施MMA方案可显著降低疼痛评分、减少术后并发症并缩短住院时间。针对目前临床实践中存在的方案标准化不足及特殊人群证据缺乏等问题，本文提出未来应向精准化、个体化及全流程疼痛管理方向发展，以进一步优化卫生经济学效益与临床转归。
Abstract: Severe pain after abdominal surgery is a key factor hindering a patient’s rapid recovery. Guided by the Accelerated Rehabilitation Surgery (ERAS) philosophy, multimodal analgesia (MMA) has shifted from empiric treatment to a perioperative core pathway that aims to minimize opioid use and its adverse effects through synergy. This article systematically reviews the latest research progress in MMA in abdominal surgery, focusing on the “low-opioidization” strategy based on NSAIDs, combined with intravenous infusion (e.g., lidocaine) and novel regional blocks (e.g., transversus abdominis plane block instead of traditional epidural). Available evidence-based medical evidence suggests that standardized implementation of MMA protocols significantly reduces pain scores, reduces postoperative complications, and shortens hospital stays. In view of the current problems of insufficient standardization of protocols and lack of evidence for special populations in clinical practice, this paper proposes to develop in the direction of precision, individualization and full-process pain management in the future, so as to further optimize the benefits of health economics and clinical outcomes.
文章引用：王帅, 赵志军, 王强. 加速康复外科(ERAS)理念下腹部手术多模式镇痛的研究进展[J]. 临床医学进展, 2026, 16(1): 1019-1028. https://doi.org/10.12677/acm.2026.161134

参考文献

[1] Wick, E.C., Grant, M.C. and Wu, C.L. (2017) Postoperative Multimodal Analgesia Pain Management with Nonopioid Analgesics and Techniques. JAMA Surgery, 152, 691-697. [Google Scholar] [CrossRef] [PubMed]
[2] Ljungqvist, O., Scott, M. and Fearon, K.C. (2017) Enhanced Recovery after Surgery. JAMA Surgery, 152, 292-298. [Google Scholar] [CrossRef] [PubMed]
[3] Soffin, E.M., Lee, B.H., Kumar, K.K. and Wu, C.L. (2019) The Prescription Opioid Crisis: Role of the Anaesthesiologist in Reducing Opioid Use and Misuse. British Journal of Anaesthesia, 122, e198-e208. [Google Scholar] [CrossRef] [PubMed]
[4] Gustafsson, U.O., Scott, M.J., Hubner, M., Nygren, J., Demartines, N., Francis, N., et al. (2018) Guidelines for Perioperative Care in Elective Colorectal Surgery: Enhanced Recovery after Surgery (ERAS®) Society Recommendations: 2018. World Journal of Surgery, 43, 659-695. [Google Scholar] [CrossRef] [PubMed]
[5] Pogatzki-Zahn, E.M., Segelcke, D. and Schug, S.A. (2017) Postoperative Pain—From Mechanisms to Treatment. PAIN Reports, 2, e588. [Google Scholar] [CrossRef] [PubMed]
[6] Neuman, M.D., Bateman, B.T. and Wunsch, H. (2019) Inappropriate Opioid Prescription after Surgery. The Lancet, 393, 1547-1557. [Google Scholar] [CrossRef] [PubMed]
[7] Wu, C.L. and Raja, S.N. (2011) Treatment of Acute Postoperative Pain. The Lancet, 377, 2215-2225. [Google Scholar] [CrossRef] [PubMed]
[8] Weibel, S., Jelting, Y., Pace, N.L., Helf, A., Eberhart, L.H., Hahnenkamp, K., et al. (2018) Continuous Intravenous Perioperative Lidocaine Infusion for Postoperative Pain and Recovery in Adults. Cochrane Database of Systematic Reviews, No. 6, CD009642. [Google Scholar] [CrossRef] [PubMed]
[9] De Oliveira, G.S., Castro-Alves, L.J., Khan, J.H. and McCarthy, R.J. (2013) Perioperative Systemic Magnesium to Minimize Postoperative Pain: A Meta-Analysis of Randomized Controlled Trials. Anesthesiology, 119, 178-190. [Google Scholar] [CrossRef] [PubMed]
[10] Kong, V.K.F. and Irwin, M.G. (2007) Gabapentin: A Multimodal Perioperative Drug? British Journal of Anaesthesia, 99, 775-786. [Google Scholar] [CrossRef] [PubMed]
[11] Block, B.M., Liu, S.S., Rowlingson, A.J., Cowan, A.R., Cowan, Jr, J.A. and Wu, C.L. (2003) Efficacy of Postoperative Epidural Analgesia. JAMA, 290, 2455-2463. [Google Scholar] [CrossRef] [PubMed]
[12] Qin, C., Liu, Y., Xiong, J., Wang, X., Dong, Q., Su, T., et al. (2020) The Analgesic Efficacy Compared Ultrasound-Guided Continuous Transverse Abdominis Plane Block with Epidural Analgesia Following Abdominal Surgery: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. BMC Anesthesiology, 20, Article No. 52. [Google Scholar] [CrossRef] [PubMed]
[13] Desai, N., El‐Boghdadly, K. and Albrecht, E. (2020) Epidural vs. Transversus Abdominis Plane Block for Abdominal Surgery—A Systematic Review, Meta‐Analysis and Trial Sequential Analysis. Anaesthesia, 76, 101-117. [Google Scholar] [CrossRef] [PubMed]
[14] Sandhu, H.K., Miller, C.C., Tanaka, A., Estrera, A.L. and Charlton-Ouw, K.M. (2021) Effectiveness of Standard Local Anesthetic Bupivacaine and Liposomal Bupivacaine for Postoperative Pain Control in Patients Undergoing Truncal Incisions: A Randomized Clinical Trial. JAMA Network Open, 4, e210753. [Google Scholar] [CrossRef] [PubMed]
[15] Vereen, M.S., Bidault, V.J., Krabbendam, E., Hoeks, S.E., Stolker, R.J. and Dirckx, M. (2025) The Effectiveness of Liposomal Bupivacaine in Ultrasound‐Guided Abdominal Wall Blocks after Open Abdominal Surgery: A Systematic Review. Pain Practice, 25, e70016. [Google Scholar] [CrossRef] [PubMed]
[16] Zhang, L., Yang, S., Liu, X., Chen, L., Zhou, X., Mao, W., et al. (2025) Impact of Liposomal Bupivacaine on Subjective Recovery Quality after Surgery: A Meta-Analysis of Randomized Controlled Trials. Frontiers in Medicine, 12, Article 1655756. [Google Scholar] [CrossRef] 
[17] Li, M., Wang, W., Yang, Y. and Wang, Y. (2025) Efficacy of Bupivacaine Liposome Transversus Abdominis Plane Block in Enhancing Postoperative Recovery Following Laparoscopic Colorectal Cancer Resection. Langenbeck’s Archives of Surgery, 410, Article No. 286. [Google Scholar] [CrossRef] 
[18] Saad Sayed, M., Rath, S., Rasool, W., Saeed, F., Kashif, H. and Amer, M. (2025) Efficacy of Liposomal Bupivacaine versus Standard Bupivacaine Following Abdominal Surgeries: A Systematic Review and Meta‐Analysis of Randomized Controlled Trials. Pain Practice, 25, e70048. [Google Scholar] [CrossRef] [PubMed]
[19] Saha, R. (2025) Liposomal vs Standard Bupivacaine: Which Is Superior in Abdominal Procedures?
https://www.gastroenterologyadvisor.com/news/liposomal-vs-standard-bupivacaine-in-abdominal-procedures/
[20] Brodersen, F., Wagner, J., Uzunoglu, F.G. and Petersen‐Ewert, C. (2023) Impact of Preoperative Patient Education on Postoperative Recovery in Abdominal Surgery: A Systematic Review. World Journal of Surgery, 47, 937-947. [Google Scholar] [CrossRef] [PubMed]
[21] Powell, R., Scott, N.W., Manyande, A., Bruce, J., Vögele, C., Byrne-Davis, L.M., et al. (2016) Psychological Preparation and Postoperative Outcomes for Adults Undergoing Surgery under General Anaesthesia. Cochrane Database of Systematic Reviews, No. 5, CD00864. [Google Scholar] [CrossRef] [PubMed]
[22] Vlug, M.S., Wind, J., Hollmann, M.W., Ubbink, D.T., Cense, H.A., Engel, A.F., et al. (2011) Laparoscopy in Combination with Fast Track Multimodal Management Is the Best Perioperative Strategy in Patients Undergoing Colonic Surgery: A Randomized Clinical Trial (LAFA-Study). Annals of Surgery, 254, 868-875. [Google Scholar] [CrossRef] [PubMed]
[23] Yassen, K., Serag Eldin, M., Mahoud, F., El Hassan, R., Abdel Raouf, M., Afifi, M., et al. (2014) Intravenous Patient-Controlled Fentanyl with and without Transversus Abdominis Plane Block in Cirrhotic Patients Post Liver Resection. Local and Regional Anesthesia, 7, 27-37. [Google Scholar] [CrossRef] [PubMed]
[24] Kinoshita, J., Fushida, S., Kaji, M., Oyama, K., Fujimoto, D., Hirono, Y., et al. (2018) A Randomized Controlled Trial of Postoperative Intravenous Acetaminophen Plus Thoracic Epidural Analgesia vs. Thoracic Epidural Analgesia Alone after Gastrectomy for Gastric Cancer. Gastric Cancer, 22, 392-402. [Google Scholar] [CrossRef] [PubMed]
[25] Warren, J.A., Carbonell, A.M., Jones, L.K., Mcguire, A., Hand, W.R., Cancellaro, V.A., et al. (2019) Length of Stay and Opioid Dose Requirement with Transversus Abdominis Plane Block vs Epidural Analgesia for Ventral Hernia Repair. Journal of the American College of Surgeons, 228, 680-686. [Google Scholar] [CrossRef] [PubMed]
[26] Strode, M.A., Sherman, W., Mangieri, C.W., Bland, C.M., Sparks, P.J., Faler, B.J., et al. (2016) Randomized Trial of OFIRMEV versus Placebo for Pain Management after Laparoscopic Sleeve Gastrectomy. Surgery for Obesity and Related Diseases, 12, 772-777. [Google Scholar] [CrossRef] [PubMed]
[27] Bongiovanni, T., Lancaster, E., Behrends, M., Zhang, L., Wick, E., Auerbach, A., et al. (2023) Optimizing Uptake of Multimodal Pain Management after Surgery Using the Electronic Health Record. JAMA Surgery, 158, 1108-1111. [Google Scholar] [CrossRef] [PubMed]
[28] Blumenthal, R.N., Locke, A.R., Ben-Isvy, N., Hasan, M.S., Wang, C., Belanger, M.J., et al. (2024) A Retrospective Comparison Trial Investigating Aggregate Length of Stay Post Implementation of Seven Enhanced Recovery after Surgery (ERAS) Protocols between 2015 and 2022. Journal of Clinical Medicine, 13, Article 5847. [Google Scholar] [CrossRef] [PubMed]
[29] Kaye, A., Urman, R., Rappaport, Y., Siddaiah, H., Cornett, E., Belani, K., et al. (2019) Multimodal Analgesia as an Essential Part of Enhanced Recovery Protocols in the Ambulatory Settings. Journal of Anaesthesiology Clinical Pharmacology, 35, 40-45. [Google Scholar] [CrossRef] [PubMed]
[30] Huang, L., Zhang, T., Wang, K., Chang, B., Fu, D. and Chen, X. (2024) Postoperative Multimodal Analgesia Strategy for Enhanced Recovery after Surgery in Elderly Colorectal Cancer Patients. Pain and Therapy, 13, 745-766. [Google Scholar] [CrossRef] [PubMed]
[31] Ferreira do Couto, M.L., Fonseca, S. and Pozza, D.H. (2024) Pharmacogenetic Approaches in Personalized Medicine for Postoperative Pain Management. Biomedicines, 12, Article 729. [Google Scholar] [CrossRef] [PubMed]
[32] Moka, E., Aguirre, J.A., Sauter, A.R. and Lavand’homme, P. (2025) Chronic Postsurgical Pain and Transitional Pain Services: A Narrative Review Highlighting European Perspectives. Regional Anesthesia & Pain Medicine, 50, 205-212. [Google Scholar] [CrossRef] [PubMed]
[33] Deshler, B.J., Rockenbach, E., Patel, T., Monahan, B.V. and Poggio, J.L. (2023) Current Update on Multimodal Analgesia and Nonopiate Surgical Pain Management. Current Problems in Surgery, 60, Article ID: 101332. [Google Scholar] [CrossRef] [PubMed]
[34] Pulskamp, T.G., Johnson, L.M. and Berlau, D.J. (2024) Novel Non-Opioid Analgesics in Pain Management. Pain Management, 14, 641-651. [Google Scholar] [CrossRef] [PubMed]
[35] Liu, F. and Panagiotakos, D. (2022) Real-World Data: A Brief Review of the Methods, Applications, Challenges and Opportunities. BMC Medical Research Methodology, 22, Article No. 287. [Google Scholar] [CrossRef] [PubMed]

为你推荐