Gan Tong J, Epstein Robert S, Leone-Perkins Megan L, Salimi Tehseen, Iqbal Sheikh Usman, Whang Peter G
Department of Anesthesiology, Stony Brook University, Stony Brook, NY, USA.
Epstein Health, LLC, Woodcliff Lake, NJ, USA.
Pain Ther. 2018 Dec;7(2):205-216. doi: 10.1007/s40122-018-0106-9. Epub 2018 Oct 26.
The management of acute postoperative pain remains a significant challenge for physicians. Poorly controlled postoperative pain is associated with poorer overall outcomes.
Between April and May 2017, physicians from an online database who regularly prescribe intravenous (IV) medications for acute postoperative pain completed a 47-question survey on topics such as patient demographics, IV analgesia preferences, factors that influence prescribing decisions, and the challenges and unmet needs for the treatment of acute postoperative pain.
Of 501 surveyed physicians, 55% practiced in community hospitals, 60% had been in practice for > 10 years, and 60% were surgeons. The three categories of IV pain medications most likely to be prescribed to patients with moderate-to-severe pain immediately after surgery were morphine, hydromorphone, or fentanyl (95.8% of respondents); COX-2 inhibitors or nonsteroidal anti-inflammatory drugs (73.7%); and acetaminophen (60.5%). Past clinical experience (81.6%), surgery type (78.2%), and onset of analgesia (67.1%) were practice-related factors that most determined their medication choice. Key patient-related risk factors, such as avoidance of medication-related adverse events (AEs), each influenced prescription decisions in > 75.0% of physicians. Nausea and vomiting were among the most common challenges associated with postoperative pain management (76.2 and 60.3%, respectively), and avoidance of analgesic medication-related AEs was among the three most influential patient-related factors that determined prescribing decision (75%). Physicians reported the top unmet need for acute pain management in patients experiencing moderate-to-severe postoperative pain was more medications with fewer side effects (i.e., nausea, vomiting, and respiratory depression; 80.7%).
Opioids remain an integral component of multimodal acute analgesic therapy for acute postoperative pain in hospitalized patients. The use of all IV analgesic medications is limited by concerns over AEs, particularly with opioids and in high-risk patients. There remains a key unmet need for effective analgesic medications that are associated with a lower risk of AEs.
Trevena, Inc.
术后急性疼痛的管理仍然是医生面临的重大挑战。术后疼痛控制不佳与整体预后较差相关。
2017年4月至5月期间，来自在线数据库、定期为术后急性疼痛开具静脉注射（IV）药物的医生完成了一项包含47个问题的调查，主题包括患者人口统计学、静脉镇痛偏好、影响处方决策的因素以及术后急性疼痛治疗的挑战和未满足的需求。
在501名接受调查的医生中，55%在社区医院执业，60%从业超过10年，60%为外科医生。术后立即用于中重度疼痛患者的三类最常用静脉止痛药物为吗啡、氢吗啡酮或芬太尼（95.8%的受访者）；COX-2抑制剂或非甾体抗炎药（73.7%）；对乙酰氨基酚（60.5%）。既往临床经验（81.6%）、手术类型（78.2%）和镇痛起效时间（67.1%）是最能决定其药物选择的与执业相关因素。关键的与患者相关的风险因素，如避免药物相关不良事件（AE），在超过75.0%的医生中均影响处方决策。恶心和呕吐是与术后疼痛管理相关的最常见挑战（分别为76.2%和60.3%），避免镇痛药物相关AE是决定处方决策的三个最具影响力的与患者相关因素之一（75%）。医生报告，对于术后中重度疼痛患者，急性疼痛管理最未满足需求是副作用更少的更多药物（即恶心、呕吐和呼吸抑制；80.7%）。
阿片类药物仍然是住院患者术后急性疼痛多模式镇痛治疗的重要组成部分。所有静脉镇痛药物的使用都受到对不良事件担忧的限制，尤其是阿片类药物以及高危患者。对于与较低不良事件风险相关的有效镇痛药物，仍存在关键的未满足需求。
Trevena公司
