综述
ENGLISH ABSTRACT
口腔外科术后疼痛的护理策略与挑战
刘春兰
胡莉为
谭小凤
作者及单位信息
·
DOI: 10.3760/cma.j.cn112144-20241223-00503
Nursing strategies and challenges in managing postoperative pain in oral surgery
Liu Chunlan
Hu Liwei
Tan Xiaofeng
Authors Info & Affiliations
Liu Chunlan
Department of Oral Surgery, West China Hospital of Stomatology, Sichuan University & State Key Laboratory of Oral Diseases & National Center for Stomatology & National Clinical Research Center for Oral Diseases, Chengdu 610044, China
Hu Liwei
Department of Oral Surgery, West China Hospital of Stomatology, Sichuan University & State Key Laboratory of Oral Diseases & National Center for Stomatology & National Clinical Research Center for Oral Diseases, Chengdu 610044, China
Tan Xiaofeng
Department of Oral Surgery, West China Hospital of Stomatology, Sichuan University & State Key Laboratory of Oral Diseases & National Center for Stomatology & National Clinical Research Center for Oral Diseases, Chengdu 610044, China
·
DOI: 10.3760/cma.j.cn112144-20241223-00503
70
21
0
0
0
0
PDF下载
APP内阅读
摘要

有效的口腔外科术后疼痛管理对提升患者护理质量至关重要。口腔区域的高敏感性和复杂的神经网络,对口腔外科术后疼痛的管理提出了显著的临床挑战。本综述评估了药物治疗方法(如非甾体抗炎药、对乙酰氨基酚和糖皮质激素)以及非药物治疗策略(如物理治疗、认知行为疗法和心理支持)的应用效果,并探讨这些方法如何共同优化疼痛管理。此外,本文还探讨了执行这些策略的挑战,包括疼痛评估的标准化、护理人员的持续教育和跨专业团队协作的重要性。通过综合这些方法,本综述旨在指导临床实践中的疼痛管理改进,以增强患者的康复效果和满意度,同时减少对药物治疗的依赖,进而提高护理服务的整体质量。

口腔外科手术;术后疼痛管理;药物治疗;非药物治疗;疼痛控制;护理实践
ABSTRACT

Effective management of postoperative pain following oral surgery is crucial for enhancing patient care quality. Given the high sensitivity of the oral region and its complex neural network, managing postoperative pain poses significant clinical challenges. This review assessed the efficacy of pharmacological treatments methods (such as non-steroidal anti-inflammatory drugs, acetaminophen and corticosteroids) and non-pharmacological treatment strategies (such as physical therapy, cognitive behavioral therapy, and psychological support), and discussed how these methods can be synergistically optimized for pain management. Additionally, this paper explored the challenges associated with implementing these strategies, including the standardization of pain assessment, the ongoing education of nursing staff, and the importance of interdisciplinary team collaboration. By integrating these approaches, this review aims to guide improvements in clinical pain management practices to enhance patient recovery outcomes and satisfaction, reduce reliance on pharmacological treatments, and ultimately elevate the overall quality of nursing care.

Oral surgical procedures;Postoperative pain management;Pharmacological treatments;Non-pharmacological treatments;Pain control;Nursing practice
Hu Liwei, Email: mocdef.qabq600866682, Tel: 0086-28-85501447
引用本文

刘春兰,胡莉为,谭小凤. 口腔外科术后疼痛的护理策略与挑战[J]. 中华口腔医学杂志,2025,60(04):431-436.

DOI:10.3760/cma.j.cn112144-20241223-00503

PERMISSIONS

Request permissions for this article from CCC.

评价本文
*以上评分为匿名评价
术后疼痛是全球性的临床挑战,不同手术类型和部位的术后疼痛发生率波动范围广泛(47%~100%) 1,反映了其普遍性及临床重要性。尽管近几十年对术后疼痛的理解和管理有了显著进展,但许多患者的疼痛管理仍不充分,导致患者慢性疼痛风险增加,住院时间延长,医疗成本上升 2
口腔外科由于区域高度敏感和复杂的神经分布,术后疼痛管理尤其复杂 3。目前,药物治疗仍是主要的疼痛管理手段,如阿片类药物和非甾体抗炎药(nonsteroidal anti-inflammatory drug,NSAID),但这些药物可能导致药物依赖、呼吸抑制等严重不良反应 4。因此,认知行为疗法(cognitive-behavioral therapy,CBT)、物理疗法和情感支持等非药物疗法已成为药物疗法的重要补充。这些方法均可有效减轻疼痛,且副作用较小、成本较低 5
口腔外科术后疼痛管理是外科治疗中不可忽视的一部分。疼痛可根据其发生机制分为急性疼痛和慢性疼痛,急性疼痛在术后24 h内较显著,并且随着手术创伤的恢复逐渐减轻;慢性疼痛则可能在术后几个月内持续存在,部分患者甚至出现神经性疼痛。此外,口腔外科术后疼痛的严重程度与手术类型、手术区域及患者的个体耐受程度密切相关。因此,术后疼痛类型和准确诊断对制定有效的疼痛管理方案至关重要。诊断疼痛时,应根据患者的主诉、疼痛持续时间、疼痛性质(如钝痛、锐痛、灼痛等)及伴随症状(如麻木、刺痛等)区分疼痛类型。在实际临床操作中,护理人员负责进行精细的疼痛评估并根据患者具体情况调整疼痛管理计划,确保患者获得最佳的疼痛控制 6。本文旨在全面探讨口腔外科术后疼痛的管理策略,详细分析药物治疗和非药物治疗的应用效果及其在护理实践中的挑战,以期为提升患者术后舒适度和满意度、优化临床护理效果提供科学依据和实践指导,同时为未来研究方向提供参考。
试读结束,您可以通过登录机构账户或个人账户后获取全文阅读权限。
参考文献
[1]
El-Tallawy SN , Nalamasu R , Salem GI ,et al. Management of musculoskeletal pain: an update with emphasis on chronic musculoskeletal pain[J]. Pain Ther, 2021,10(1):181-209. DOI: 10.1007/s40122-021-00235-2 .
返回引文位置Google Scholar
百度学术
万方数据
[2]
Malcangi G , Patano A , Guglielmo M ,et al. Precision medicine in oral health and diseases: a systematic review[J]. J Pers Med, 2023,13(5):725. DOI: 10.3390/jpm13050725 .
返回引文位置Google Scholar
百度学术
万方数据
[3]
Pergolizzi JV , Magnusson P , LeQuang JA ,et al. The pharmacological management of dental pain[J]. Expert Opin Pharmacother, 2020,21(5):591-601. DOI: 10.1080/14656566.2020.1718651 .
返回引文位置Google Scholar
百度学术
万方数据
[4]
Gianò M , Franco C , Castrezzati S ,et al. Involvement of oxidative stress and nutrition in the anatomy of orofacial pain [J]. Int J Mol Sci, 2023,24(17):13128. DOI: 10.3390/ijms241713128 .
返回引文位置Google Scholar
百度学术
万方数据
[5]
Labanca M , Gianò M , Franco C ,et al. Orofacial pain and dentistry management: guidelines for a more comprehensive evidence-based approach[J]. Diagnostics (Basel), 2023,13(17):2854. DOI: 10.3390/diagnostics13172854 .
返回引文位置Google Scholar
百度学术
万方数据
[6]
Melis M , Di Giosia M , Colloca L . Ancillary factors in the treatment of orofacial pain: a topical narrative review[J]. J Oral Rehabil, 2019,46(2):200-207. DOI: 10.1111/joor.12736 .
返回引文位置Google Scholar
百度学术
万方数据
[7]
Chang RW , Tompkins DM , Cohn SM . Are NSAIDs safe? Assessing the risk-benefit profile of nonsteroidal anti-inflammatory drug use in postoperative pain management[J]. Am Surg, 2021,87(6):872-879. DOI: 10.1177/0003134820952834 .
返回引文位置Google Scholar
百度学术
万方数据
[8]
Cramer JD , Barnett ML , Anne S ,et al. Nonopioid, Multimodal analgesia as first-line therapy after otolaryngology operations: primer on nonsteroidal anti-inflammatory drugs (NSAIDs)[J]. Otolaryngol Head Neck Surg, 2021,164(4):712-719. DOI: 10.1177/0194599820947013 .
返回引文位置Google Scholar
百度学术
万方数据
[9]
De Oliveira GS Jr, Almeida MD , Benzon HT ,et al. Perioperative single dose systemic dexamethasone for postoperative pain: a meta-analysis of randomized controlled trials[J]. Anesthesiology, 2011,115(3):575-588. DOI: 10.1097/ALN.0b013e31822a24c2 .
返回引文位置Google Scholar
百度学术
万方数据
[10]
Nehme W , Fares Y , Abou-Abbas L . Piezo-surgery technique and intramuscular dexamethasone injection to reduce postoperative pain after impacted mandibular third molar surgery: a randomized clinical trial[J]. BMC Oral Health, 2021,21(1):393. DOI: 10.1186/s12903-021-01759-x .
返回引文位置Google Scholar
百度学术
万方数据
[11]
Moore PA , Hersh EV . Combining ibuprofen and acetaminophen for acute pain management after third-molar extractions: translating clinical research to dental practice[J]. J Am Dent Assoc, 2013,144(8):898-908. DOI: 10.14219/jada.archive.2013.0207 .
返回引文位置Google Scholar
百度学术
万方数据
[12]
Thornhill MH , Suda KJ , Durkin MJ ,et al. Is it time US dentistry ended its opioid dependence?[J]. J Am Dent Assoc, 2019,150(10):883-889. DOI: 10.1016/j.adaj.2019.07.003 .
返回引文位置Google Scholar
百度学术
万方数据
[13]
Heron MJ , Nwokorie NA , O′Connor B ,et al. Survey of opioid prescribing among dentists indicates need for more effective education regarding pain management[J]. J Am Dent Assoc, 2022,153(2):110-119. DOI: 10.1016/j.adaj.2021.07.018 .
返回引文位置Google Scholar
百度学术
万方数据
[14]
Gómez-Sánchez E , Hernández-Gómez A , Guzmán-Flores JM ,et al. Celecoxib decreases the need for rescue analgesics after total knee arthroplasty: a meta-analysis[J]. Clin Pract, 2024,14(2):461-472. DOI: 10.3390/clinpract14020035 .
返回引文位置Google Scholar
百度学术
万方数据
[15]
Isiordia-Espinoza MA , Franco-González MA , Alonso-Castro ÁJ ,et al. Analgesic ef fectiveness and safety of celecoxib versus non-opioid active controls after third molar surgery: a meta-analytical evaluation [J]. J Stomatol Oral Maxillofac Surg, 2022,123(3):e1-e9. DOI: 10.1016/j.jormas.2021.06.015 .
返回引文位置Google Scholar
百度学术
万方数据
[16]
Pimenta RP , Takahashi CM , Barberato-Filho S ,et al. Preemptive use of anti-inflammatories and analgesics in oral surgery: a review of systematic reviews[J]. Front Pharmacol, 2023,14:1303382. DOI: 10.3389/fphar.2023.1303382 .
返回引文位置Google Scholar
百度学术
万方数据
[17]
Rawal N . Intrathecal opioids for the management of post-operative pain[J]. Best Pract Res Clin Anaesthe, 2023,37(2):123-132. DOI: 10.1016/j.bpa.2023.01.001 .
返回引文位置Google Scholar
百度学术
万方数据
[18]
Moussa N , Ogle OE . Acute pain management[J]. Oral Maxillofac Surg Clin North Am, 2022,34:35-47. DOI: 10.1002/bjs.11477 .
返回引文位置Google Scholar
百度学术
万方数据
[19]
Barbosa GM , Cunha JE , Cunha TM ,et al. Clinical-like cryotherapy improves footprint patterns and reduces synovial inflammation in a rat model of post-traumatic knee osteoarthritis[J]. Sci Rep, 2019,9(1):14518. DOI: 10.1038/s41598-019-50958-8 .
返回引文位置Google Scholar
百度学术
万方数据
[20]
Liu K , Liu Y , Ma X ,et al. Effect of cognitive behavioral therapy on pain, knee function, and psychological status in patients after primary total knee arthroplasty: a systematic review and meta-analysis[J]. BMC Musculoskelet Disord, 2024,25(1):280. DOI: 10.1186/s12891-024-07413-1 .
返回引文位置Google Scholar
百度学术
万方数据
[21]
Chan C , Chan A , Chu CH ,et al. Theory-based behavioral change interventions to improve periodontal health[J]. Front Oral Health, 2023,4:1067092. DOI: 10.3389/froh.2023.1067092 .
返回引文位置Google Scholar
百度学术
万方数据
[22]
Makino I , Arai YC , Aono S ,et al. Jaw exercise therapy and psyc hoeducation to reduce oral parafunctional activities for the management of persistent dentoalveolar pain [J]. Pain Res Manag, 2018,2018:5042067. DOI: 10.1155/2018/5042067 .
返回引文位置Google Scholar
百度学术
万方数据
[23]
Karamat A , Smith JG , Melek LNF ,et al. Psychologic impact of chronic orofacial pain: a critical review[J]. J Oral Facial Pain Headache, 2022,36(2):103-140. DOI: 10.11607/ofph.3010 .
返回引文位置Google Scholar
百度学术
万方数据
[24]
Priyank H , Shankar Prasad R , Shivakumar S ,et al. Management protocols of chronic orofacial pain: a systematic review[J]. Saudi Dent J, 2023,35:395-402. DOI: 10.1016/j.sdentj.2023.03.004 .
返回引文位置Google Scholar
百度学术
万方数据
[25]
Anita H , Asnely Putri F , Maulina T . The association between orofacial pain and depression: a systematic review[J]. J Pain Res, 2024,17:785-796. DOI: 10.2147/JPR.S435219 .
返回引文位置Google Scholar
百度学术
万方数据
[26]
Asadauskas A , Luedi MM , Urman RD ,et al. Modern approaches to the treatment of acute facial pain[J]. Curr Pain Headache Rep, 2024,28(8):793-801. DOI: 10.1007/s11916-024-01260-4 .
返回引文位置Google Scholar
百度学术
万方数据
[27]
Monteiro JLGC , da Silva Barbirato D , Moraes SLD ,et al. Does listening to music reduce anxiety and pain in third molar surgery?-a systematic review[J]. Clin Oral Investig, 2022,26(10):6079-6086. DOI: 10.1007/s00784-022-04640-5 .
返回引文位置Google Scholar
百度学术
万方数据
[28]
Calixtre LB , Moreira RF , Franchini GH ,et al. Manual therapy for the management of pain and limited range of motion in subjects with signs and symptoms of temporomandibular disorder: a systematic review of randomised controlled trials[J]. J Oral Rehabil, 2015,42(11):847-861. DOI: 10.1111/joor.12321 .
返回引文位置Google Scholar
百度学术
万方数据
[29]
Tan K , Liu H , Huang S ,et al. Efficacy of music intervention for dental anxiety disorders: a systematic review and meta-analysis[J]. Medicina (Kaunas), 2023,59(2):209. DOI: 10.3390/medicina59020209 .
返回引文位置Google Scholar
百度学术
万方数据
[30]
Bradt J , Dileo C , Shim M . Music interventions for preoperative anxiety[J]. Cochrane Database Syst Rev, 2013,2013(6):CD006908. DOI: 10.1002/14651858.CD006908.pub2 .
返回引文位置Google Scholar
百度学术
万方数据
[31]
Breivik H , Borchgrevink PC , Allen SM ,et al. Assessment of pain [J]. Br J Anaesth, 2008,101(1):17-24. DOI: 10.1093/bja/aen103 .
返回引文位置Google Scholar
百度学术
万方数据
[32]
Gilron I , Baron R , Jensen T . Neuropathic pain: principles of diagnosis and treatment[J]. Mayo Clin Proc, 2015,90(4):532-545. DOI: 10.1016/j.mayocp.2015.01.018 .
返回引文位置Google Scholar
百度学术
万方数据
[33]
Innab A , Alammar K , Alqahtani N ,et al. The impact of a 12-hour educational program on nurses′ knowledge and attitudes regarding pain management: a quasi-experimental study[J]. BMC Nurs, 2022,21(1):250. DOI: 10.1186/s12912-022-01028-4 .
返回引文位置Google Scholar
百度学术
万方数据
[34]
Sweity EM , Salahat AM , Sada AA ,et al. Knowledge, attitude, practice and perceived barriers of nurses working in intensive care unit on pain management of critically ill patients: a cross-sectional study[J]. BMC Nurs, 2022,21(1):202. DOI: 10.1186/s12912-022-00990-3 .
返回引文位置Google Scholar
百度学术
万方数据
[35]
Connell NB , Prathivadi P , Lorenz KA ,et al. Teaming in interdisciplinary chronic pain management interventions in primary care: a systematic review of randomized controlled trials[J]. J Gen Intern Med, 2022,37(6):1501-1512. DOI: 10.1007/s11606-021-07255-w .
返回引文位置Google Scholar
百度学术
万方数据
[36]
Fishman SM , Young HM , Lucas Arwood E ,et al. Core competencies for pain management: results of an interprofessional consensus summit[J]. Pain Med, 2013,14(7):971-981. DOI: 10.1111/pme.12107 .
返回引文位置Google Scholar
百度学术
万方数据
[37]
Maheta BJ , Singh NK , Lorenz KA ,et al. Interdisciplinary interventions that improve patient-reported outcomes in perioperative cancer care: a systematic review of randomized control trials[J]. PLoS One, 2023,18(11):e0294599. DOI: 10.1371/journal.pone.0294599 .
返回引文位置Google Scholar
百度学术
万方数据
[38]
Corry M , Neenan K , Brabyn S ,et al. Telephone interventions, delivered by healthcare professionals, for providing education and psychosocial support for informal caregivers of adults with diagnosed illnesses[J]. Cochrane Database Syst Rev, 2019,5(5):CD012533. DOI: 10.1002/14651858.CD012533.pub2 .
返回引文位置Google Scholar
百度学术
万方数据
[39]
Chen YR , Chen CC , Wu WW ,et al. Nurses′ knowledge of and attitude toward postoperative patient-controlled analgesia (PCA) and the associated factors[J]. BMC Nurs, 2024,23(1):21. DOI: 10.1186/s12912-024-01702-9 .
返回引文位置Google Scholar
百度学术
万方数据
[40]
Leroux A , <x>Rzasa-</x> <x>Lynn</x> R , Crainiceanu C ,et al. Wearable devices: current status and opportunities in pain assessment and management[J]. Digit Biomark, 2021,5(1):89-102. DOI: 10.1159/000515576 .
返回引文位置Google Scholar
百度学术
万方数据
[41]
Cerda IH , Therond A , Moreau S ,et al. Telehealth and virtual reality technologies in chronic pain management: a narrative review[J]. Curr Pain Headache Rep, 2024,28(3):83-94. DOI: 10.1007/s11916-023-01205-3 .
返回引文位置Google Scholar
百度学术
万方数据
[42]
Zhang M , Zhu L , Lin SY ,et al. Using artificial intelligence to im prove pain assessment and pain management: a scoping review [J]. J Am Med Inform Assoc, 2023,30(3):570-587. DOI: 10.1093/jamia/ocac231 .
返回引文位置Google Scholar
百度学术
万方数据
[43]
Schmierer T , Li T , Li Y . Harnessing machine learning for EEG signal analysis: innovations in depth of anaesthesia assessment[J]. Artif Intell Med, 2024,151:102869. DOI: 10.1016/j.artmed.2024.102869 .
返回引文位置Google Scholar
百度学术
万方数据
[44]
Ilyas AM , Sundaram P , Plusch K ,et al. Multimodal pain management after outpatient orthopedic hand surgery: a prospective randomized trial[J]. J Hand Surg Glob Online, 2024,6(1):16-20. DOI: 10.1016/j.jhsg.2023.07.021 .
返回引文位置Google Scholar
百度学术
万方数据
[45]
Cheung CW , Ching Wong SS , Qiu Q ,et al. Oral oxycodone for acute postoperative pain: a review of clinical trials[J]. Pain Physician, 2017,20(2S):SE33-SE52.
返回引文位置Google Scholar
百度学术
万方数据
[46]
Kanschik D , Bruno RR , Wolff G ,et al. Virtual and augmented reality in intensive care medicine: a systematic review[J]. Ann Intensive Care, 2023,13(1):81. DOI: 10.1186/s13613-023-01176-z .
返回引文位置Google Scholar
百度学术
万方数据
[47]
Staguhn ED , Kirkhart T , Allen L ,et al. Predictors of participation in online self-management programs: a longitudinal observational study[J]. Rehabil Psychol, 2024,69(2):102-109. DOI: 10.1037/rep0000521 .
返回引文位置Google Scholar
百度学术
万方数据
[48]
Wick EC , Grant MC , Wu CL . Postoperative multimodal analgesia pain management with nonopioid analgesics and techniques: a review[J]. JAMA Surg, 2017,152(7):691-697. DOI: 10.1001/jamasurg.2017.0898 .
返回引文位置Google Scholar
百度学术
万方数据
[49]
Xuan C , Yan W , Wang D ,et al. Efficacy of preemptive analgesia treatments for the management of postoperative pain: a network meta-analysis[J]. Br J Anaesth, 2022,129(6):946-958. DOI: 10.1016/j.bja.2022.08.038 .
返回引文位置Google Scholar
百度学术
万方数据
[50]
Pirie K , Traer E , Finniss D ,et al. Current approaches to acute postoperative pain management after major abdominal surgery: a narrative review and future directions[J]. Br J Anaesth, 2022,129(3):378-393. DOI: 10.1016/j.bja.2022.05.029 .
返回引文位置Google Scholar
百度学术
万方数据
[51]
Liu Y , Zhang J , Yu P ,et al. Mechanisms and efficacy of intravenous lipid emulsion treatment for systemic toxicity from local anesthetics[J]. Front Med ( Lausanne) , 2021,8:756866. DOI: 10.3389/fmed.2021.756866 .
返回引文位置Google Scholar
百度学术
万方数据
[52]
Paladini G , Di Carlo S , Musella G ,et al. Continuous wound infiltration of local anesthetics in postoperative pain management: safety, efficacy and current perspectives[J]. J Pain Res, 2020,13:285-294. DOI: 10.2147/JPR.S211234 .
返回引文位置Google Scholar
百度学术
万方数据
备注信息
A
胡莉为,Email: mocdef.qabq600866682,电话:028-85501447
B

刘春兰:论文起草和修改;胡莉为:参与研究设计、参与撰写论文;谭小凤:参与论文撰写和修订

C
刘春兰, 胡莉为, 谭小凤. 口腔外科术后疼痛的护理策略与挑战[J]. 中华口腔医学杂志, 2025, 60(4): 431-436. DOI: 10.3760/cma.j.cn112144-20241223-00503.
D
所有作者声明不存在利益冲突
评论 (0条)
注册
登录
时间排序
暂无评论,发表第一条评论抢沙发
MedAI助手(体验版)
文档即答
智问智答
机器翻译
回答内容由人工智能生成,我社无法保证其准确性和完整性,该生成内容不代表我们的态度或观点,仅供参考。
生成快照
文献快照

你好,我可以帮助您更好的了解本文,请向我提问您关注的问题。

0/2000

《中华医学会杂志社用户协议》 | 《隐私政策》

《SparkDesk 用户协议》 | 《SparkDesk 隐私政策》

网信算备340104764864601230055号 | 网信算备340104726288401230013号

技术支持:

历史对话
本文全部
还没有聊天记录
设置
模式
纯净模式沉浸模式
字号