Soffin Ellen M, Waldman Seth A, Stack Roberta J, Liguori Gregory A
From the Department of Anesthesiology, Hospital for Special Surgery, New York, New York.
Anesth Analg. 2017 Nov;125(5):1704-1713. doi: 10.1213/ANE.0000000000002433.
Orthopedic surgery is associated with significant perioperative pain. Providing adequate analgesia is a critical component of patient care and opioids play a vital role in the acute postoperative setting. However, opioid prescribing for patients undergoing orthopedic procedures has recently been identified as a major contributor to the current opioid epidemic. As opioid usage and related morbidity and mortality continue to rise nationwide, opioid-prescribing practices are under increased scrutiny. Here, we update the evidence base and recommendations behind a set of interventions developed at the Hospital for Special Surgery to address the national epidemic at the local level. The main components of our program include (1) guidelines for managing patients who are opioid tolerant and/or have a substance abuse disorder; (2) education programs for patients, emphasizing the role of opioids in recovery after elective orthopedic surgery; (3) education programs for prescribers of controlled substances, including clinical and regulatory aspects; (4) the development of surgery-specific prescribing recommendations for opioid-naive patients; and (5) mechanisms to modify prescribing habits to limit unnecessary prescribing of controlled substances.
骨科手术伴随着显著的围手术期疼痛。提供充分的镇痛是患者护理的关键组成部分，而阿片类药物在术后急性期起着至关重要的作用。然而，最近已确定为接受骨科手术的患者开具阿片类药物是当前阿片类药物流行的主要促成因素。随着全国范围内阿片类药物使用以及相关发病率和死亡率持续上升，阿片类药物的处方行为受到了越来越多的审查。在此，我们更新了特种外科医院制定的一系列干预措施背后的证据基础和建议，以在地方层面应对全国性的阿片类药物流行问题。我们项目的主要组成部分包括：（1）管理对阿片类药物耐受和/或患有物质使用障碍患者的指南；（2）针对患者的教育项目，强调阿片类药物在择期骨科手术后恢复中的作用；（3）针对管制药品处方者的教育项目，包括临床和监管方面；（4）为未使用过阿片类药物的患者制定特定手术的处方建议；以及（5）改变处方习惯以限制管制药品不必要处方的机制。
