Velasco David, Simonovich Shannon D, Krawczyk Susan, Roche Bernadette
is a graduate of North-shore School of Nurse Anesthesia and is currently in clinical practice at Franciscan St Anthony in Crown Point, Indiana.
is an assistant professor at DePaul University School of Nursing, Chicago, Illinois.
AANA J. 2019 Dec;87(6):459-467.
Opioids are the mainstay of intraoperative pain control, but they have several deleterious effects. Alternative medications and strategies to opioids, while effective in producing intraoperative analgesia, are underutilized by anesthesia providers. The purpose of this study was to examine and describe Certified Registered Nurse Anesthetists' perspectives and practices on administering opioids vs nonopioid or opioid-sparing strategies ("opioid alternatives") to treat intraoperative pain. A qualitative study design using semistructured interviews was conducted (N = 12). Study participants described their perspectives and practices on treating intraoperative pain. Two key themes emerged: (1) barriers to intraoperative opioid-alternative administration and (2) facilitators to intraoperative opioid-alternative administration. Barriers expressed by study participants included opioid superiority, inconsistent analgesic effects of intraoperative opioid alternatives, limited experience with opioid alternatives, limited resources on opioid alternatives, negative experiences with intraoperative opioid-alternative administration, and patient comorbidities. Facilitators expressed by study participants included the adverse effects of opioids, institutional policy and procedures, positive experiences with opioid-alternative administration, and regional anesthesia superiority. This study highlights the importance of improving education, training, and institutional policies in support of opioid-alternative medications and strategies to treat intraoperative pain and better prevent opioid addiction and abuse.
阿片类药物是术中疼痛控制的主要手段，但它们有多种有害影响。阿片类药物的替代药物和策略虽然在产生术中镇痛效果方面有效，但麻醉医护人员对其利用不足。本研究的目的是探讨和描述注册护士麻醉师在使用阿片类药物与非阿片类或阿片类药物节省策略（“阿片类药物替代方法”）治疗术中疼痛方面的观点和做法。采用半结构化访谈进行了一项定性研究设计（N = 12）。研究参与者描述了他们在治疗术中疼痛方面的观点和做法。出现了两个关键主题：（1）术中阿片类药物替代方法给药的障碍，以及（2）术中阿片类药物替代方法给药的促进因素。研究参与者表示的障碍包括阿片类药物的优越性、术中阿片类药物替代方法镇痛效果不一致、对阿片类药物替代方法经验有限、阿片类药物替代方法资源有限、术中阿片类药物替代方法给药的负面经历以及患者合并症。研究参与者表示的促进因素包括阿片类药物的不良反应、机构政策和程序、阿片类药物替代方法给药的积极经历以及区域麻醉的优越性。本研究强调了改进教育、培训和机构政策以支持用于治疗术中疼痛的阿片类药物替代药物和策略并更好地预防阿片类药物成瘾和滥用的重要性。
