Generelt

Kunnskap om skadelige effekter av postoperativ smerte og tilgjengelige metoder for effektiv behandling gir grunnlag for en aktiv tilnærming til postoperativ smertebehandling. Utilstrekkelig smertelindring forsterker stressresponsen og disponerer for kardial iskemi, svekker immunforsvaret og øker risikoen for tromboemboliske komplikasjoner. Smertebetinget inaktivitet og redusert ventilasjons- og hostekraft fører til sekretstagnasjon, ev. atelektaser og pneumoni og forlenget sykehusopphold. Smerter hemmer normal tarm- og blærefunksjon. Risiko for kroniske smerter etter kirurgi øker muligens når pasienten har sterke akutte postoperative smerter.

Den postoperative smertebehandlingen bør planlegges preoperativt. Kontinuerlig per- og postoperativ blokkering av smerteimpulser med ulike metoder og ulike typer analgetika i et multimodalt regime gir additive effekter og reduserer bivirkningene. Ved behov gis i tillegg opioider titrert til effekt.

Kilder

Bell RF et al. Peri-operative ketamine for acute postoperative pain: a quantitative and qualitative systematic review (Cochrane review). Acta Anaesthesiol Scand 2005;49:1405-1428 

Elia N, Tramer MR. Ketamine and postoperative pain - a guantitative systematic review of randomized trials. Pain 2005;113:61-70 

Lauren K Dunn. Perioperative Use of Intravenous Lidocaine. Anesthesiology 4 2017, Vol.126, 729-737 

Ho KY et al. Gabapentin and postoperative pain - a systematic review of randomized controlled trials. Pain 2006;126:91-100 

Dahl JB et al. 'Protective premedication': an option with gabapentin and related drugs. Acta Anaesthesiol Scand 2004;48:1130-1136 

Derry and Moore. Single dose oral celecoxib for acute postoperative pain in adults. Cochrane Database Syst Rev. 2013 Oct 22;10:CD004233. doi: 10.1002/14651858.CD004233.pub4. PMID: 24150982 

Derry S, Moore RA, Clarke R. Single dose oral etoricoxib for acute postoperative pain in adults. Cochrane Database Syst Rev. 2014 May 8;5:CD004309. doi: 10.1002/14651858.CD004309.pub4. PMID: 24809657 

Lloyd, Derry et al.. Intravenous or intramuscular parecoxib for acute postoperative pain in adults. Cochrane Database Syst Rev. 2009 Apr 15;(2):CD004771. doi:0.1002/14651858.CD004771.pub4. PMID: 19370610 

Hullett, Salman et al. Development of a population pharmacokinetic model for parecoxib and its active metabolite valdecoxib after parenteral parecoxib administration in children. Anesthesiology. 2012 May;116(5):1124-33. doi: 10.1097/ALN.0b013e31825154ef. PMID: 22450476 

Brattwall M, Lundeberg S, Ericsson E. Treatment of pain and nausea associated with tonsil surgery. New guidelines for the pharmacological treatment of children and adolescents. Lakartidningen. 2014 Oct 8-14;111(41):1775-7. Review

Kehlet H. Local infiltration analgesia in joint replacement: the evidence and recommendations for clinical practice. Acta Anaesthesiol Scand. 2011 Aug;55(7):778-84 

Clarke R, Derry S, Moore RA. Single dose oral etoricoxib for acute postoperative pain in adults. Cochrane Database Syst Rev. 2014 May 8;2014(5):CD004309. doi: 10.1002/14651858.CD004309.pub4. PMID: 24809657; PMCID: PMC6485336. 

Turner S, Ford V. Role of the selective cyclo-oxygenase-2 (COX-2) inhibitors in children. Archives of Disease in Childhood - Education and Practice 2004;89:ep46-ep49. 

Webside. Stefan Lundeberg, Eva Malmros Olsson, Ulla Caverius . Riktlinjer för smärtbehandling hos barn – akut och postoperativ smärta. https://sfai.se/wp-content/uploads/2020/03/Riktlinjer-f%C3%B6r-sm%C3%A4rtbehandling-hos-barn-SFAI-2020-02-04.pdf Lest 29.10.24 

Mitchell, C., Cheuk, S.J., O’Donnell, C.M. et al. What is the impact of dexamethasone on postoperative pain in adults undergoing general anaesthesia for elective abdominal surgery: a systematic review and meta-analysis. Perioper Med 11, 13 (2022). https://doi.org/10.1186/s13741-022-00243-6 

De Oliveira GS Jr, Almeida MD, Benzon HT, McCarthy RJ. Perioperative single dose systemic dexamethasone for postoperative pain: a meta-analysis of randomized controlled trials. Anesthesiology. 2011 Sep;115(3):575-88. doi: 10.1097/ALN.0b013e31822a24c2. PMID: 21799397. 

Jain R, Dua CK. Comparative analgesic efficacy of different doses of dexamethasone during infraumbilical surgery: A Randomized controlled trial. Anesth Essays Res. 2015 Jan-Apr;9(1):34-8. doi: 10.4103/0259-1162.150153. PMID: 25886418; PMCID: PMC4383110. 

Spoorenberg SM, Deneer VH, Grutters JC, Pulles AE, Voorn GP, Rijkers GT, Bos WJ, van de Garde EM. Pharmacokinetics of oral vs. intravenous dexamethasone in patients hospitalized with community-acquired pneumonia. Br J Clin Pharmacol. 2014 Jul;78(1):78-83. doi: 10.1111/bcp.12295. PMID: 24400953; PMCID: PMC4168382. 

O'Connell RS, Clinger BN, Donahue EE, Celi FS, Golladay GJ. Dexamethasone and postoperative hyperglycemia in diabetics undergoing elective hip or knee arthroplasty: a case control study in 238 patients. Patient Saf Surg. 2018 Nov 5;12:30. doi: 10.1186/s13037-018-0178-9. PMID: 30410577; PMCID: PMC6217772. 

Volkmar AJ, Schultz JD, Rickert MM, Polkowski GG, Engstrom SM, Martin JR. Dexamethasone Is Associated With a Statistically Significant Increase in Postoperative Blood Glucose Levels Following Primary Total Knee Arthroplasty. Arthroplast Today. 2023 Jan 3;19:101076. doi: 10.1016/j.artd.2022.101076. PMID: 36624747; PMCID: PMC9823113. 

Denyer S, Ramini A, Eikani C, Murphy MP, Brown N. Effect of Preoperative Corticosteroids on Postoperative Glucose Control in Total Joint Arthroplasty. Arthroplast Today. 2023 Nov 21;24:101238. doi: 10.1016/j.artd.2023.101238. PMID: 38077928; PMCID: PMC10700152. 

Kaur S, Saroa R, Aggarwal S. Effect of intraoperative infusion of low-dose ketamine on management of postoperative analgesia. J Nat Sci Biol Med. 2015 Jul-Dec;6(2):378-82. doi: 10.4103/0976-9668.160012. PMID: 26283834; PMCID: PMC4518414. 

Brinck EC, Tiippana E, Heesen M, Bell RF, Straube S, Moore RA, Kontinen V. Perioperative intravenous ketamine for acute postoperative pain in adults. Cochrane Database Syst Rev. 2018 Dec 20;12(12):CD012033. doi: 10.1002/14651858.CD012033.pub4. PMID: 30570761; PMCID: PMC6360925. 

Tsai SHL, Hu CW, El Sammak S, Durrani S, Ghaith AK, Lin CCJ, Krzyz EZ, Bydon M, Fu TS, Lin TY. Different Gabapentin and Pregabalin Dosages for Perioperative Pain Control in Patients Undergoing Spine Surgery: A Systematic Review and Network Meta-Analysis. JAMA Netw Open. 2023 Aug 1;6(8):e2328121. doi: 10.1001/jamanetworkopen.2023.28121. PMID: 37556139; PMCID: PMC10413173. 

Mao Y, Wu L, Ding W. The efficacy of preoperative administration of gabapentin/pregabalin in improving pain after total hip arthroplasty: a meta-analysis. BMC Musculoskelet Disord. 2016 Aug 30;17(1):373. doi: 10.1186/s12891-016-1231-4. PMID: 27577678; PMCID: PMC5004259. 

Blaber OK, Aman ZS, DePhillipo NN, LaPrade RF, Dekker TJ. Perioperative Gabapentin May Reduce Opioid Requirement for Early Postoperative Pain in Patients Undergoing Anterior Cruciate Ligament Reconstruction: A Systematic Review of Randomized Controlled Trials. Arthroscopy. 2023 Jul;39(7):1761-1772. doi: 10.1016/j.arthro.2022.11.024. Epub 2022 Dec 8. PMID: 36682946. 

Straube S, Derry S, Moore RA, Wiffen PJ, McQuay HJ. Single dose oral gabapentin for established acute postoperative pain in adults. Cochrane Database of Systematic Reviews 2010, Issue 5. Art. No.: CD008183. DOI: 10.1002/14651858.CD008183.pub2 

Grégoire Blaudszun, Christopher Lysakowski, Nadia Elia, Martin R. Tramèr; Effect of Perioperative Systemic α2 Agonists on Postoperative Morphine Consumption and Pain Intensity: Systematic Review and Meta-analysis of Randomized Controlled Trials. Anesthesiology 2012; 116:1312–1322 doi: https://doi.org/10.1097/ALN.0b013e31825681cb

Lambert P, Cyna AM, Knight N, Middleton P. Clonidine premedication for postoperative analgesia in children. Cochrane Database Syst Rev. 2014 Jan 28;2014(1):CD009633. doi: 10.1002/14651858.CD009633.pub2. PMID: 24470114; PMCID: PMC10646408.