Devin Clinton J, Lee Dennis S, Armaghani Sheyan J, Bible Jesse, Shau David N, Martin Peter R, Ehrenfeld Jesse M
J Am Acad Orthop Surg. 2014 Oct;22(10):614-22. doi: 10.5435/JAAOS-22-10-614.
Opioids are commonly used for the management of pain in patients with musculoskeletal disorders; however, national attention has highlighted the potential adverse effects of the use of opioid analgesia in this and other nonmalignant pain settings. Chronic opioid users undergoing orthopaedic surgery represent a particularly challenging patient population in regard to their perioperative pain control and outcomes. Preoperative evaluation provides an opportunity to estimate a patient's preoperative opioid intake, discuss pain-related fears, and identify potential psychiatric comorbidities. Patients using high levels of opioids may also require referral to an addiction specialist. Various regional blockade and pharmaceutical options are available to help control perioperative pain, and a multimodal pain management approach may be of particular benefit in chronic opioid users undergoing orthopaedic surgery.
阿片类药物常用于治疗肌肉骨骼疾病患者的疼痛；然而，全国范围内的关注凸显了在这种及其他非恶性疼痛情况下使用阿片类镇痛药物的潜在不良反应。接受骨科手术的慢性阿片类药物使用者在围手术期疼痛控制和预后方面是一个特别具有挑战性的患者群体。术前评估提供了一个机会来估计患者术前阿片类药物的摄入量、讨论与疼痛相关的担忧，并识别潜在的精神疾病共病。使用高剂量阿片类药物的患者可能还需要转诊至成瘾专科医生处。有多种区域阻滞和药物选择可用于帮助控制围手术期疼痛，多模式疼痛管理方法可能对接受骨科手术的慢性阿片类药物使用者特别有益。
