Pharmacotherapy Outcomes Research Center, University of Utah College of Pharmacy, Salt Lake City, Utah 84112, USA.
Pharmacotherapy. 2012 Sep;32(9 Suppl):6S-11S. doi: 10.1002/j.1875-9114.2012.01177.x.
The majority of patients who undergo surgery will require drug therapy for the management of acute postsurgical pain. Effective control of acute postsurgical pain is essential for the patient not only in the short term but also in the long term to prevent the development of chronic pain, which can occur if early acute pain is prolonged. Currently, opioid analgesics are widely used for the management of acute postsurgical pain. Although opioids provide effective postsurgical pain relief, their use is associated with a number of risks, including the development of opioid-related adverse drug events (ORADEs). This review investigates the prevalence of opioid use in the postsurgical setting, the incidence of ORADEs, and the impact of these ORADEs on patient outcomes, length of stay, and costs after common surgeries. According to a national analysis of ORADE incidence, almost 20% of patients treated with opioids experienced an ORADE, with the most common being gastrointestinal effects, central nervous system effects, pruritus, or urinary retention. Studies show that the risk of developing an ORADE is higher in patients receiving higher doses of opioids and in patients undergoing orthopedic or gynecologic surgery compared with patients undergoing general surgery. Elderly patients and those with comorbidities (e.g., obesity, sleep apnea, respiratory disease, urinary disorders) may be particularly vulnerable to ORADE development. Both hospital costs and length of stay are increased in patients with an ORADE versus those without an ORADE. Strategies to reduce the use of opioids after surgery are likely to result in positive outcomes by reducing the incidence of ORADEs and, as a result, reducing treatment costs associated with surgery and improving patient care.
大多数接受手术的患者将需要药物治疗来管理急性术后疼痛。有效控制急性术后疼痛不仅对患者的短期而且对长期都至关重要，以防止慢性疼痛的发展，如果早期急性疼痛持续时间延长，可能会发生慢性疼痛。目前，阿片类镇痛药广泛用于急性术后疼痛的管理。尽管阿片类药物提供了有效的术后疼痛缓解，但它们的使用与许多风险相关，包括发生与阿片类药物相关的不良药物事件（ORADE）。本综述调查了围手术期阿片类药物使用的流行率、ORADE 的发生率，以及这些 ORADE 对患者术后结局、住院时间和成本的影响。根据对 ORADE 发生率的全国性分析，接受阿片类药物治疗的患者中，近 20%经历了 ORADE，最常见的是胃肠道效应、中枢神经系统效应、瘙痒或尿潴留。研究表明，接受更高剂量阿片类药物和接受骨科或妇科手术的患者比接受普通外科手术的患者发生 ORADE 的风险更高。老年患者和合并症（如肥胖、睡眠呼吸暂停、呼吸疾病、泌尿系统疾病）患者可能特别容易发生 ORADE 发展。与没有 ORADE 的患者相比，发生 ORADE 的患者的住院费用和住院时间都增加了。减少手术后阿片类药物使用的策略可能会通过降低 ORADE 的发生率从而带来积极的结果，从而降低与手术相关的治疗成本并改善患者护理。
