Department of Anesthesiology and Pharmacology, Toxicology, and Neurosciences, Louisiana State University School of Medicine, Shreveport, LA, USA.
Tulane University School of Medicine, New Orleans, LA, 70112, USA.
Curr Pain Headache Rep. 2020 Apr 2;24(5):21. doi: 10.1007/s11916-020-00853-z.
Effective acute pain management has evolved considerably in recent years and is a primary area of focus in attempts to defend against the opioid epidemic. Persistent postsurgical pain (PPP) has an incidence of up to 30-50% and has negative outcome of quality of life and negative burden on individuals, family, and society. The 2016 American Society of Anesthesiologists (ASA) guidelines states that enhanced recovery after surgery (ERAS) forms an integral part of Perioperative Surgical Home (PSH) and is now recommended to use a multimodal opioid-sparing approach for management of postoperative pain. As such, dexmedetomidine is now being used as part of ERAS protocols along with regional nerve blocks and other medications, to create a satisfactory postoperative outcome with reduced opioid consumption in the Post anesthesia care unit (PACU).
Dexmedetomidine, a selective alpha agonist, possesses analgesic effects and has a different mechanism of action when compared with opioids. When dexmedetomidine is initiated at the end of a procedure, it has a better hemodynamic stability and pain response than ropivacaine. Dexmedetomidine can be used as an adjuvant in epidurals with local anesthetic sparing effects. Its use during nerve blocks results in reduced postoperative pain. Also, local infiltration of IV dexmedetomidine is associated with earlier discharge from PACU. Perioperative use of dexmedetomidine has significantly improved postoperative outcomes when used as part of ERAS protocols. An in-depth review of the use of dexmedetomidine in ERAS protocols is presented for clinical anesthesiologists.
近年来，急性疼痛的有效管理有了很大的发展，并且是试图抵御阿片类药物流行的主要关注领域。持续性手术后疼痛（PPP）的发生率高达 30-50%，对生活质量有负面影响，并给个人、家庭和社会带来沉重负担。2016 年美国麻醉医师学会（ASA）指南指出，手术后恢复增强（ERAS）是围手术期外科之家（PSH）的一个组成部分，现在建议使用多模式阿片类药物节约方法来管理术后疼痛。因此，右美托咪定现在被用作 ERAS 方案的一部分，与区域神经阻滞和其他药物一起，在麻醉后护理单元（PACU）中减少阿片类药物的使用，以获得满意的术后效果。
右美托咪定是一种选择性α激动剂，具有镇痛作用，与阿片类药物的作用机制不同。当右美托咪定在手术结束时开始使用时，与罗哌卡因相比，它具有更好的血液动力学稳定性和疼痛反应。右美托咪定可作为硬膜外麻醉的辅助药物，具有局部麻醉节约作用。其在神经阻滞中的应用可减轻术后疼痛。此外，静脉内右美托咪定局部浸润与 PACU 更早出院有关。围手术期使用右美托咪定作为 ERAS 方案的一部分时，显著改善了术后结果。为临床麻醉医师介绍了右美托咪定在 ERAS 方案中的使用情况。
