Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Lucile Packard Children's Hospital Stanford, Stanford, CA.
Clin J Pain. 2019 Jun;35(6):463-467. doi: 10.1097/AJP.0000000000000702.
The entire field of medicine, not just anesthesiology, has grown comfortable with the risks posed by opioids; but these risks are unacceptably high. It is time for a dramatic paradigm shift. If used at all for acute or chronic pain management, they should be used only after consideration and maximizing the use of nonopioid pharmacologic agents, regional analgesia techniques, and nonpharmacologic methods. Opioids poorly control pain, their intraoperative use may increase the risk of recurrence of some types of cancer, and they have a large number of both minor and serious side effects. Furthermore, there are a myriad of alternative analgesic strategies that provide superior analgesia, decrease recovery time, and have fewer side effects and risks associated with their use. In this article the negative consequences of opioid use for pain, appropriate alternatives to opioids for analgesia, and the available evidence in pediatric populations for both are described.
整个医学领域，而不仅仅是麻醉学，已经对阿片类药物带来的风险感到习以为常；但这些风险高得令人无法接受。现在是时候进行戏剧性的范式转变了。如果出于急性或慢性疼痛管理的目的而使用阿片类药物，那么只有在考虑并最大限度地使用非阿片类药物、区域镇痛技术和非药物方法之后，才能使用它们。阿片类药物在控制疼痛方面效果不佳，它们在手术中的使用可能会增加某些类型癌症复发的风险，而且它们有大量轻微和严重的副作用。此外，还有无数种替代镇痛策略可以提供更好的镇痛效果，缩短恢复时间，并且与使用它们相关的副作用和风险更少。本文描述了阿片类药物在疼痛治疗方面的负面影响、阿片类药物的替代方法，以及这两种方法在儿科人群中的现有证据。
