Department of Anaesthesia and Pain Medicine, Raigmore Hospital, Inverness, UK.
Department of Vascular Surgery, University Hospital Wales, Cardiff, UK.
Br J Anaesth. 2021 Jun;126(6):1208-1216. doi: 10.1016/j.bja.2021.02.030. Epub 2021 Apr 14.
There are significant concerns regarding prescription and misuse of prescription opioids in the perioperative period. The Faculty of Pain Medicine at the Royal College of Anaesthetists have produced this evidence-based expert consensus guideline on surgery and opioids along with the Royal College of Surgery, Royal College of Psychiatry, Royal College of Nursing, and the British Pain Society. This expert consensus practice advisory reproduces the Faculty of Pain Medicine guidance. Perioperative stewardship of opioids starts with judicious opioid prescribing in primary and secondary care. Before surgery, it is important to assess risk factors for continued opioid use after surgery and identify those with chronic pain before surgery, some of whom may be taking opioids. A multidisciplinary perioperative care plan that includes a prehabilitation strategy and intraoperative and postoperative care needs to be formulated. This may need the input of a pain specialist. Emphasis is placed on optimum management of pain pre-, intra-, and postoperatively. The use of immediate-release opioids is preferred in the immediate postoperative period. Attention to ensuring a smooth care transition and communication from secondary to primary care for those taking opioids is highlighted. For opioid-naive patients (patients not taking opioids before surgery), no more than 7 days of opioid prescription is recommended. Persistent use of opioid needs a medical evaluation and exclusion of chronic post-surgical pain. The lack of grading of the evidence of each individual recommendation remains a major weakness of this guidance; however, evidence supporting each recommendation has been rigorously reviewed by experts in perioperative pain management.
在围手术期，人们对处方和滥用处方类阿片类药物存在严重担忧。皇家麻醉师学院疼痛医学系与皇家外科学院、皇家精神病学院、皇家护理学院和英国疼痛学会共同制定了这份基于证据的手术与阿片类药物专家共识指南。这份专家共识实践建议复制了疼痛医学系的指导意见。围手术期阿片类药物管理从初级和二级保健中的合理阿片类药物处方开始。手术前，评估手术后继续使用阿片类药物的风险因素并识别出手术前患有慢性疼痛的患者非常重要，其中一些患者可能正在服用阿片类药物。需要制定包括术前康复策略以及术中、术后护理的多学科围手术期护理计划。这可能需要疼痛专家的参与。重点是优化围手术期疼痛的管理。在术后即刻，建议使用即释型阿片类药物。强调确保服用阿片类药物的患者从二级护理顺利过渡到初级护理并保持沟通。对于阿片类药物初治患者（手术前未服用阿片类药物的患者），建议开具不超过 7 天的阿片类药物处方。需要对持续使用阿片类药物进行医学评估并排除慢性术后疼痛。尽管本指南的一个主要弱点仍然是对每个单独建议的证据没有进行分级，但对围手术期疼痛管理专家进行了严格审查以支持每个建议的证据。
