Clarke Hance A, Manoo Varuna, Pearsall Emily A, Goel Akash, Feinberg Adina, Weinrib Aliza, Chiu Jenny C, Shah Bansi, Ladak Salima S J, Ward Sarah, Srikandarajah Sanjho, Brar Savtaj S, McLeod Robin S
Department of Anaesthesia and Pain Management, Toronto General Hospital, Toronto, Ontario, Canada.
Transitional Pain Service, Department of Anaesthesia and Pain Management, Toronto General Hospital, Toronto, Ontario, Canada.
Can J Pain. 2020 Mar 8;4(1):67-85. doi: 10.1080/24740527.2020.1724775.
This Consensus Statement provides recommendations on the prescription of pain medication at discharge from hospital for opioid-naïve adult patients who undergo elective surgery. It encourages health care providers (surgeons, anesthesiologists, nurses/nurse practitioners, pain teams, pharmacists, allied health professionals, and trainees) to (1) use nonopioid therapies and reduce the prescription of opioids so that fewer opioid pills are available for diversion and (2) educate patients and their families/caregivers about pain management options after surgery to optimize quality of care for postoperative pain. These recommendations apply to opioid-naïve adult patients who undergo elective surgery. This consensus statement is intended for use by health care providers involved in the management and care of surgical patients. A modified Delphi process was used to reach consensus on the recommendations. First, the authors conducted a scoping review of the literature to determine current best practices and existing guidelines. From the available literature and expertise of the authors, a draft list of recommendations was created. Second, the authors asked key stakeholders to review and provide feedback on several drafts of the document and attend an in-person consensus meeting. The modified Delphi stakeholder group included surgeons, anesthesiologists, residents, fellows, nurses, pharmacists, and patients. After multiple iterations, the document was deemed complete. The recommendations are not graded because they are mostly based on consensus rather than evidence.
本共识声明针对接受择期手术的未使用过阿片类药物的成年患者出院时的止痛药物处方提供建议。它鼓励医疗保健提供者(外科医生、麻醉师、护士/执业护士、疼痛治疗团队、药剂师、相关健康专业人员及实习生):(1)使用非阿片类疗法并减少阿片类药物的处方,从而减少可用于转移的阿片类药丸数量;(2)对患者及其家属/护理人员进行术后疼痛管理选项的教育,以优化术后疼痛的护理质量。这些建议适用于接受择期手术的未使用过阿片类药物的成年患者。本共识声明供参与外科患者管理和护理的医疗保健提供者使用。采用了改良的德尔菲法就这些建议达成共识。首先,作者对文献进行了范围界定审查,以确定当前的最佳实践和现有指南。根据现有文献和作者的专业知识,制定了一份建议草案清单。其次,作者请关键利益相关者对该文件的多个草案进行审查并提供反馈,并参加一次面对面的共识会议。改良的德尔菲利益相关者小组包括外科医生、麻醉师、住院医师、研究员、护士、药剂师和患者。经过多次迭代后,该文件被认为完成。这些建议未进行分级,因为它们大多基于共识而非证据。