Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, 02115, USA.
Curr Pain Headache Rep. 2022 Sep;26(9):701-708. doi: 10.1007/s11916-022-01073-3. Epub 2022 Aug 12.
This review outlines the psychiatric comorbidities associated with persistent opioid use in the postoperative period. We finish our analysis with evidence-based, patient-centered interventions that can be rendered in the perioperative setting to decrease postoperative opioid requirements.
Opioids are overprescribed in the USA, especially in the postoperative setting. Excess opioids can result in diversion and contribute to the ongoing opioid epidemic. Mental health and substance use disorders can contribute to persistent postoperative opioid use. Adequately managing these disorders preoperatively promises to reduce persistent postoperative opioid use. Due to the lack of homogenous, evidence-based recommendations on the appropriate quantity and duration of postoperative opioid therapy, there is wide variability in provider prescribing habits. Further research is needed to establish surgery-specific postoperative opioid therapy protocols. Opioids continue to be a mainstay in the treatment of postoperative pain. Unmonitored postoperative opioid use can lead to opioid use disorder. Mental health disorders increase susceptibility to persistent postoperative opioid use. By managing these psychiatric illnesses preoperatively, clinicians have the ability to decrease opioid consumption postoperatively. Lastly, given the healthcare burden of opioid misuse and abuse, it is important to establish concrete protocols to guide provider-prescribing habits.
本文概述了术后持续使用阿片类药物相关的精神共病。我们在分析中纳入了基于循证、以患者为中心的干预措施，这些措施可在围手术期实施，以减少术后阿片类药物的需求。
阿片类药物在美国，尤其是在术后使用过度。过量的阿片类药物可导致滥用，并导致持续的阿片类药物流行。精神健康和物质使用障碍可导致术后持续使用阿片类药物。在术前充分管理这些疾病可有望减少术后持续使用阿片类药物。由于缺乏针对术后阿片类药物治疗适当剂量和持续时间的同质、基于证据的推荐，提供者的处方习惯存在很大差异。需要进一步的研究来建立特定于手术的术后阿片类药物治疗方案。阿片类药物仍然是治疗术后疼痛的主要药物。未监测的术后阿片类药物使用可导致阿片类药物使用障碍。精神疾病增加了术后持续使用阿片类药物的易感性。通过术前管理这些精神疾病，临床医生有能力减少术后阿片类药物的使用。最后，鉴于阿片类药物滥用对医疗保健的负担，建立具体的方案来指导提供者的处方习惯非常重要。
