Sullivan Denise, Lyons Mary, Montgomery Robert, Quinlan-Colwell Ann
Anesthesiology/Pain Management Service, Jacobi Medical Center, Bronx, New York (Ms Sullivan); Inpatient Pain Management, Northwestern Medicine-Central DuPage Hospital, Winfield, Illinois (Ms Lyons); Anesthesiology, University of Colorado Hospital, Aurora, Colorado (Dr Montgomery); and Clinical Outcomes, New Hanover Regional Medical Center, Wilmington, North Carolina (Dr Quinlan-Colwell).
J Trauma Nurs. 2016 Nov/Dec;23(6):361-375. doi: 10.1097/JTN.0000000000000250.
Challenges with opioids (e.g., adverse events, misuse and abuse with long-term administration) have led to a renewed emphasis on opioid-sparing multimodal management of trauma pain. To assess the extent to which currently available evidence supports the efficacy and safety of various nonopioid analgesics and techniques to manage trauma pain, a literature search of recently published references was performed. Additional citations were included on the basis of authors' knowledge of the literature. Effective options for opioid-sparing analgesics include oral and intravenous (IV) acetaminophen; nonsteroidal anti-inflammatory drugs available via multiple routes; and anticonvulsants, which are especially effective for neuropathic pain associated with trauma. Intravenous routes (e.g., IV acetaminophen, IV ketorolac) may be associated with a faster onset of action than oral routes. Additional adjuvants for the treatment of trauma pain are muscle relaxants and alpha-2 adrenergic agonists. Ketamine and regional techniques play an important role in multimodal therapy but require medical and nursing support. Nonpharmacologic treatments (e.g., cryotherapy, distraction techniques, breathing and relaxation, acupuncture) supplement pharmacologic analgesics and can be safe and easy to implement. In conclusion, opioid-sparing multimodal analgesia addresses concerns associated with high doses of opioids, and many pharmacologic and nonpharmacologic options are available to implement this strategy. Nurses play key roles in comprehensive patient assessment; administration of patient-focused, opioid-sparing, multimodal analgesia in trauma; and monitoring for safety concerns.
阿片类药物存在诸多问题（如不良事件、长期使用导致的误用和滥用），这使得人们重新重视创伤疼痛的阿片类药物节省型多模式管理。为评估现有证据在何种程度上支持各种非阿片类镇痛药及技术用于管理创伤疼痛的有效性和安全性，我们对近期发表的参考文献进行了文献检索。此外，还根据作者对文献的了解纳入了其他引用文献。阿片类药物节省型镇痛药的有效选择包括口服和静脉注射对乙酰氨基酚；可通过多种途径给药的非甾体抗炎药；以及对抗与创伤相关的神经性疼痛特别有效的抗惊厥药。静脉给药途径（如静脉注射对乙酰氨基酚、静脉注射酮咯酸）的起效可能比口服途径更快。用于治疗创伤疼痛的其他辅助药物是肌肉松弛剂和α-2肾上腺素能激动剂。氯胺酮和区域技术在多模式治疗中发挥着重要作用，但需要医疗和护理支持。非药物治疗（如冷冻疗法、分散注意力技术、呼吸与放松、针灸）可补充药物镇痛，且安全易实施。总之，阿片类药物节省型多模式镇痛解决了与高剂量阿片类药物相关的问题，并且有许多药物和非药物选择可用于实施这一策略。护士在全面的患者评估、对创伤患者实施以患者为中心的阿片类药物节省型多模式镇痛以及监测安全问题方面发挥着关键作用。
