Department of Anesthesiology, Critical Care and Pain, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, Maharashtra, India. ORCID: https://orcid.org/0000-0003-4313-7659.
Department of Anesthesiology, Critical Care and Pain, Advanced Centre for Treatment Research and Education in Cancer (ACTREC), Homi Bhabha National Institute, Navi-Mumbai, Maharashtra, India. ORCID: https://orcid.org/0000-0001-8945-2174.
J Opioid Manag. 2021 Sep-Oct;17(5):417-437. doi: 10.5055/jom.2021.0675.
Opioids are an indispensable part of perioperative pain management of cancer surgeries. Opioids do have some side effects and abuse potential, and some laboratory data suggest a possible association of cancer recurrence with perioperative opioid use. Opioid-free anesthesia and opioid-sparing anesthesia are emerging new concepts worldwide to safeguard patients from adverse effects of opioids and potential abuse. Opioid-free anesthesia could lead to ineffective pain management, leaving the perioperative physician with limited options, while opioid-sparing anesthesia may be a rational approach. This consensus guideline includes general considerations of the safe use of perioperative opioids along with concomitant use of central neuraxial or regional blockade and systematic nonopioid analgesics. Region-specific onco-surgeries with their specific recommendations and consensus statements for judicious use of opioids are suggested. Use of epidural analgesia or regional catheter during thoracic, abdominal, pelvic, and lower limb surgeries and use of regional nerve blocks/catheter in head neck, neuro, and upper limb onco-surgeries, wherever possible along with nonopioids analgesics, are suggested. Short-acting opioids in small aliquots may be allowed to control breakthrough pain for expedient control of pain. The purpose of this consensus practice guideline is to provide the practicing anesthesiologists with best practice evidence and consensus recommendations by the expert committee of the Society of Onco-Anesthesia and Perioperative Care for safe opioid use in onco-surgeries.
阿片类药物是癌症手术围手术期疼痛管理不可或缺的一部分。阿片类药物确实有一些副作用和滥用的可能性，一些实验室数据表明，围手术期使用阿片类药物可能与癌症复发有关。无阿片类麻醉和阿片类药物节约型麻醉是全球新兴的新概念，旨在保护患者免受阿片类药物的不良反应和潜在滥用的影响。无阿片类麻醉可能导致疼痛管理无效，使围手术期医生的选择有限，而阿片类药物节约型麻醉可能是一种合理的方法。本共识指南包括围手术期阿片类药物安全使用的一般注意事项，以及同时使用中枢神经轴或区域阻滞和系统非阿片类镇痛药。建议针对特定部位的肿瘤手术，以及明智使用阿片类药物的具体建议和共识声明。建议在胸部、腹部、骨盆和下肢手术中使用硬膜外镇痛或区域导管，在头颈部、神经和上肢肿瘤手术中使用区域神经阻滞/导管，尽可能与非阿片类镇痛药一起使用。建议使用小剂量的短效阿片类药物来控制爆发性疼痛，以便迅速控制疼痛。本共识实践指南的目的是为执业麻醉师提供最佳实践证据和共识建议，由肿瘤麻醉和围手术期护理学会的专家委员会提供，以确保在肿瘤手术中安全使用阿片类药物。
