加拿大关节镜协会关于关节镜手术后阿片类药物处方的立场声明
Nicholas Nucci1, Ryan Degen2, Seper Ekhtiari3
1University of Ottawa, Ottawa, Ontario, Canada.
Orthopaedic journal of sports medicine
|December 25, 2023
概括
非阿片类药物疼痛管理策略有效地减少了关节镜手术后的阿片类药物使用,而不会影响疼痛缓解. 建议使用多式止痛,冷治疗和神经刺激来管理关节镜后疼痛.
科学领域:
- 整形外科手术 整形外科手术
- 疼痛管理 疼痛管理
- 药理学 药理学是指药理学的学科.
背景情况:
- 持续的阿片类药物流行需要减少阿片类药物处方来治疗关节镜术后的疼痛.
- 整形外科医生需要达成共识,并为有效的止痛策略提供解决方案.
- 目前的做法往往涉及关节镜手术后大量的阿片类药物处方.
研究的目的:
- 为了综合证据,在关节镜手术后管理急性术后疼痛.
- 为阿片类药物节约止痛策略提供建议.
- 通过对随机对照试验 (RCT) 的系统审查和元分析,为最佳实践提供信息.
主要方法:
- 专门针对RCT的系统审查和元分析.
- 在Embase,MEDLINE,PubMed,Scopus和Web of Science数据库中进行搜索,直到2022年8月.
- 包括接受关节镜手术的成年患者的RCT,重点是疼痛和阿片类药物消费.
主要成果:
- 21个RCT提供了关于阿片类药物缓解疼痛的建议.
- 多式口服非阿片类止痛药 (乙氨基+NSAID) 显著降低了阿片类药物消耗,但没有影响疼痛评分.
- 低温疗法,穿皮电神经刺激和放松炼显示出潜在的益处,尽管证据各不相同.
- 透皮利多卡因贴片在减少阿片类药物消费方面表现出有限的有效性.
结论:
- 非阿片类药物策略可以有效地减少术后阿片类药物消费,同时保持疼痛控制.
- 最佳的疼痛管理包括多模式止痛,患者教育和明智的阿片类药物处方.
- 证据支持在关节镜手术后转向非阿片类药物中心的疼痛管理协议.
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