Smith Kathryn, Wang Michelle, Abdukalikov Ruslan, McAullife Amy, Whitesell Dena, Richard Janelle, Sauer William, Quaye Aurora
Department of Pharmacy, Maine Medical Center, Portland, Maine, USA.
Department of Pharmacy, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA.
J Clin Pharmacol. 2022 Apr;62(4):449-462. doi: 10.1002/jcph.1999. Epub 2022 Jan 5.
The opioid epidemic has resulted in increased opioid-related critical care admissions, presenting challenges in acute pain management. Limited guidance exists in the management of critically ill patients with opioid use disorder (OUD). This narrative review provides the intensive care unit clinician with guidance and treatment options, including nonopioid analgesia, for patients receiving medications for OUD and for patients actively misusing opioids. Verification and continuation of the patient's outpatient medications for OUD regimen, specifically buprenorphine and methadone formulations; assessment of pain and opioid withdrawal; and treatment of acute pain with nonopioid analgesia, nonpharmacologic strategies, and short-acting opioids as needed, are all essential to adequate management of acute pain in patients with OUD. A multidisciplinary approach to treatment and discharge planning in patients with OUD may be beneficial to engage patients with OUD early in their hospital stay to prevent withdrawal, stabilize their OUD, and reduce the risk of unplanned discharge and other associated morbidity.
阿片类药物流行导致与阿片类药物相关的重症监护住院人数增加，给急性疼痛管理带来了挑战。对于患有阿片类药物使用障碍（OUD）的重症患者，管理方面的指导有限。这篇叙述性综述为重症监护病房的临床医生提供了指导和治疗选择，包括针对接受OUD治疗药物的患者以及积极滥用阿片类药物的患者的非阿片类镇痛方法。核实并继续患者的OUD门诊用药方案，特别是丁丙诺啡和美沙酮制剂；评估疼痛和阿片类药物戒断症状；根据需要使用非阿片类镇痛药、非药物策略和短效阿片类药物治疗急性疼痛，这些对于充分管理患有OUD的患者的急性疼痛至关重要。对患有OUD的患者采用多学科治疗和出院计划方法，可能有助于在患者住院早期就使其参与进来，以防止戒断反应、稳定其OUD病情，并降低计划外出院及其他相关发病率的风险。
