Kaye Alan David, Armstead-Williams Cassandra, Hyatali Farees, Cox Katherine S, Kaye Rachel J, Eng Lauren K, Farooq Anwar Muhammad A, Patel Perene V, Patil Shilpa, Cornett Elyse M
Department Pharmacology, Toxicology, and Neuroscience, LSU Health Shreveport, Shreveport, LA, USA.
Department of Anesthesia, Department of Anesthesiology, LSU Health Sciences Center, Room 656, 1542 Tulane Ave., New Orleans, LA, 70112, USA.
Curr Pain Headache Rep. 2020 Oct 23;24(11):73. doi: 10.1007/s11916-020-00905-4.
Multimodal pain management is the most effective way to treat postsurgical pain. However, the use of opioids for acute pain management has unfortunately been a significant contributor to the current opioid epidemic. The use of opioids should be limited and only considered a "rescue" pain medication after other modalities of pain management have been utilized.
It may be difficult to curtail the use of opioids in the treatment of chronic pain; however, in the postsurgical setting, there is compelling evidence that an opioid-centric analgesic approach is not necessary for good patient outcomes and healthcare cost benefits. Opioid-related adverse effects are the leading cause of preventable harm in the hospital setting. After the realization in recent years of the many harmful effects of opioids, alternative regimens including the use of multimodal analgesia have become a standard practice in acute pain management. Exparel, a long-lasting liposomal bupivacaine local anesthetic agent, has many significant benefits in the management of postoperative pain. Overall, the literature suggests that Exparel may be a significant component for postoperative multimodal pain control owing to its efficacy and long duration of action.
多模式疼痛管理是治疗术后疼痛最有效的方法。然而,不幸的是,使用阿片类药物进行急性疼痛管理已成为当前阿片类药物流行的一个重要因素。阿片类药物的使用应受到限制,只有在使用了其他疼痛管理方式之后,才应将其视为“急救”止痛药物。
在慢性疼痛治疗中减少阿片类药物的使用可能很困难;然而,在术后环境中,有令人信服的证据表明,以阿片类药物为中心的镇痛方法对于良好的患者预后和医疗成本效益并非必要。阿片类药物相关的不良反应是医院环境中可预防伤害的主要原因。在近年来认识到阿片类药物的诸多有害影响之后,包括使用多模式镇痛在内的替代方案已成为急性疼痛管理的标准做法。Exparel(一种长效脂质体布比卡因局部麻醉剂)在术后疼痛管理中有许多显著益处。总体而言,文献表明,由于其疗效和长效作用,Exparel可能是术后多模式疼痛控制的一个重要组成部分。