Wampole Chelsea R, Smith Kathryn E
1 Department of Pharmacy, Maine Medical Center, Portland, ME, USA.
J Pharm Pract. 2019 Jun;32(3):256-270. doi: 10.1177/0897190019834479. Epub 2019 Mar 7.
Critically ill patients commonly experience pain, and the provision of analgesia is an essential component of intensive care unit (ICU) care. Opioids are the mainstay of pain management in the ICU but are limited by their adverse effects, risk of addiction and abuse, and recent drug shortages of injectable formulations. A multimodal analgesia approach, utilizing nonopioid analgesics as adjuncts to opioid therapy, is recommended since they may modulate the pain response and reduce opioid requirements by acting on multiple pain mediators. Nonopioid analgesics discussed in detail in this article are acetaminophen, α-2 receptor agonists, gabapentinoids, ketamine, lidocaine, and nonsteroidal anti-inflammatory drugs. This literature review describes the clinical pharmacology, supportive ICU and relevant non-ICU data, and practical considerations associated with the administration of nonopioid analgesics in critically ill adult patients.
危重症患者常伴有疼痛，提供镇痛治疗是重症监护病房（ICU）护理的重要组成部分。阿片类药物是ICU疼痛管理的主要药物，但受其不良反应、成瘾和滥用风险以及近期注射用剂型药物短缺的限制。推荐采用多模式镇痛方法，将非阿片类镇痛药作为阿片类药物治疗的辅助药物，因为它们可能通过作用于多种疼痛介质来调节疼痛反应并减少阿片类药物的用量。本文详细讨论的非阿片类镇痛药有对乙酰氨基酚、α-2受体激动剂、加巴喷丁类药物、氯胺酮、利多卡因和非甾体抗炎药。这篇文献综述描述了非阿片类镇痛药在成年危重症患者中的临床药理学、ICU及相关非ICU支持数据以及用药实际注意事项。
