Department of Anesthesiology, Stony Brook University Health Science Center, Stony Brook, NY, USA.
Department of Neurosurgery, Stony Brook University Health Science Center, Stony Brook, NY, USA.
Expert Opin Drug Saf. 2021 May;20(5):549-559. doi: 10.1080/14740338.2021.1898583. Epub 2021 Mar 17.
Postoperative pain is one of the most common adverse events after surgery and has been shown to increase the risk of other complications. On the other hand, liberal opioid use in the perioperative period is also associated with risk of adverse events. The current consensus is therefore to provide multimodal, opioid minimizing analgesia after surgery.In this review, we will discuss the benefits and risks associated with non-opioid analgesics, including non-steroidal anti-inflammatory drugs, gabapentinoids, ketamine, α-2 agonists, and corticosteroids. In addition, we will discuss the general and block-specific risks associated with regional anesthestic techniques.Adverse events associated with non-opioid analgesics are rare outside their specific contraindicated patient groups, especially when dosed appropriately. α-2 agonists can cause transient hypotension and bradycardia, and gabapentinoids may cause sedation in higher risk patient populations. Regional anesthesia techniques are generally safe when done by an experienced practitioner. We therefore encourage the development of standardized multimodal analgesic protocols, which may facilitate opioid minimization and lead to better patient outcomes.
术后疼痛是手术后最常见的不良反应之一,已被证明会增加其他并发症的风险。另一方面,围手术期阿片类药物的广泛使用也与不良事件的风险相关。因此,目前的共识是在手术后提供多模式、阿片类药物最小化的镇痛。在这篇综述中,我们将讨论非阿片类镇痛药(包括非甾体抗炎药、加巴喷丁类药物、氯胺酮、α-2 激动剂和皮质类固醇)相关的益处和风险。此外,我们还将讨论与区域麻醉技术相关的一般和特定阻滞风险。非阿片类镇痛药的不良事件在其特定禁忌患者群体之外很少发生,尤其是在适当剂量的情况下。α-2 激动剂可引起短暂的低血压和心动过缓,加巴喷丁类药物在高风险患者群体中可能引起镇静。区域麻醉技术在由经验丰富的从业者进行时通常是安全的。因此,我们鼓励制定标准化的多模式镇痛方案,这可能有助于阿片类药物的最小化,并导致更好的患者结局。