在阿片类药物流行时代,外科手术期间疼痛的优化
Janki Patel1, Kyle Snyder, Amber K Brooks
1Department of Anesthesiology, Section on Pain Medicine, Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA.
Current opinion in anaesthesiology
|April 4, 2024
概括
解决阿片类药物流行需要优化术后疼痛管理. 多模式止痛 (MMA) 和手术后增强恢复 (ERAS) 协议改善了结果,而布普伦诺芬管理和过渡性疼痛服务帮助复杂的患者.
科学领域:
- 麻醉学 麻醉学
- 疼痛管理 疼痛管理
- 公共卫生 公共卫生
背景情况:
- 阿片类药物流行病构成了重大的社会威胁,COVID-19大流行加剧了这种威胁.
- 外科期间的阿片类药物使用和处方与阿片类药物使用障碍 (OUD) 的发展有关.
- 优化术后疼痛管理对于减轻阿片类药物相关伤害至关重要.
研究的目的:
- 审查当前的多模式止痛疗法 (MMA) 建议.
- 总结关于外科手术后增强恢复 (ERAS) 协议在术后疼痛管理方面的证据.
- 讨论在接受手术的OUD患者中使用布普伦诺芬以及过渡性疼痛服务的作用.
主要方法:
- 对MMA和ERAS协议的最新文献进行系统审查.
- 对OUD手术患者中布普伦诺芬管理的当前指南的分析.
- 探索支持复杂患者群体过渡性疼痛服务的证据.
主要成果:
- 多模式止痛 (MMA) 提供了显著的好处,尽管最佳的药物组合需要进一步的研究.
- 手术后增强恢复 (ERAS) 协议为MMA实施和全面的术后疼痛管理提供了一个结构化的方法.
- 目前的指导建议,对于接受手术的OUD患者,不建议例行停止或逐渐减少布普伦诺芬.
- 过渡性疼痛服务显示出管理复杂患者的新证据,包括患有慢性疼痛或物质使用障碍的患者.
结论:
- 周围手术的医生必须认识到阿片类药物流行病的影响.
- 实施MMA技术,ERAS协议和过渡性疼痛服务可以增强外科手术期间的疼痛体验.
- 这些策略对于降低在外科手术期间与阿片类药物使用相关的风险至关重要.
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