Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital, 75 Francis Street, Boston, MA, 02115, USA.
Center for Perioperative Research, Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
Curr Pain Headache Rep. 2021 Mar 24;25(5):27. doi: 10.1007/s11916-021-00943-6.
This review aims to summarize interventions used in the perioperative period to reduce the development of new persistent postoperative opioid use in opioid-naïve patients.
The development of new persistent opioid use after surgery has recently been identified as a common postoperative complication. The existing literature suggests that interventions across the continuum of care have been shown to decrease the incidence of new persistent postoperative opioid use. Specific preoperative, intraoperative, and postoperative interventions will be reviewed, as well as the use of clinical pathways and protocols that span throughout the perioperative period. Common to many of these interventions include the use of multimodal analgesia throughout the perioperative period and an emphasis on a patient-centered, evidence-based approach to the perioperative pain management plan. While the incidence of new persistent postoperative opioid use appears to be high, the literature suggests that there are both small- and large-scale interventions that can be used to reduce this. Technological advances including prescription monitoring systems and mobile applications have enabled studies to monitor opioid consumption after discharge. Interventions that occur preoperatively, such as patient education and expectation setting regarding postoperative pain management, and interventions that occur postoperatively, such as the implementation of procedure-specific, evidence-based prescribing guidelines and protocols, have been shown to reduce post-discharge opioid consumption. The use of multimodal analgesia and opioid-sparing adjuncts throughout the perioperative period is central to many of these interventions and has essentially become standard of care for management of perioperative pain.
本篇综述旨在总结围手术期干预措施，以减少无阿片类药物使用史患者新发生持续性术后阿片类药物使用。
术后新发生持续性阿片类药物使用最近被确定为一种常见的术后并发症。现有文献表明，贯穿整个围手术期的各种干预措施已被证明可降低新发生持续性术后阿片类药物使用的发生率。将对特定的术前、术中和术后干预措施，以及贯穿围手术期使用的临床路径和方案进行综述，这些干预措施通常包括在围手术期使用多模式镇痛，并强调以患者为中心、基于证据的围手术期疼痛管理计划方法。虽然新发生持续性术后阿片类药物使用的发生率似乎很高，但文献表明，有小范围和大范围的干预措施可用于降低这种发生率。包括处方监测系统和移动应用程序在内的技术进步，使研究能够监测出院后的阿片类药物使用情况。术前干预措施，如患者教育和对术后疼痛管理的期望设定，以及术后干预措施，如实施特定于手术的、基于证据的处方指南和方案，已被证明可减少出院后的阿片类药物使用。在围手术期全程使用多模式镇痛和阿片类药物节约性辅助药物是这些干预措施的核心，并且已基本成为围手术期疼痛管理的标准。
