Boysen Philip G, Patel Jenilkumar H, King Angelle N
Emeritus Professor and Chair, The University of North Carolina at Chapel Hill, Chapel Hill, NC.
Tulane University School of Medicine, New Orleans, LA.
Ochsner J. 2023 Spring;23(1):43-49. doi: 10.31486/toj.22.0065.
Opioids and derivatives of opium had been used as analgesics for thousands of years before the introduction of inhalational anesthetic agents. Once these early volatile agents were in widespread use, opioids were used as part of anesthetic care for premedication, as intraoperative adjuncts to general anesthesia, and for the management of postoperative pain. Evidence of growing dependence on opioids in the perioperative and periprocedural patient is supported by the ongoing research to develop synthetic opioids and to customize the pharmacokinetics and pharmacodynamics to achieve specific therapeutic goals. We explore the history of opioid use in perioperative care as a means of future management in light of new persistent opioid abuse. As the opium chemical structure has been modified, newer nonopioid analgesics have been approved and brought into clinical practice. Opioid-sparing and opioid-free anesthetic techniques are not only a possibility, but a reality. Continuing research in neurobiology and addiction genetics will ultimately lead to a pharmacogenetic approach to patients at risk for new persistent opioid abuse.
在吸入性麻醉剂出现之前，阿片类药物及其鸦片衍生物作为镇痛药已被使用了数千年。一旦这些早期挥发性麻醉剂广泛应用，阿片类药物就被用作麻醉护理的一部分，用于术前用药、作为全身麻醉的术中辅助药物以及用于术后疼痛管理。围手术期和围手术过程中患者对阿片类药物依赖增加的证据，得到了正在进行的开发合成阿片类药物以及定制药代动力学和药效学以实现特定治疗目标研究的支持。鉴于新出现的持续性阿片类药物滥用情况，我们探讨围手术期护理中使用阿片类药物的历史，作为未来管理的一种手段。随着鸦片化学结构的改变，更新的非阿片类镇痛药已获批准并应用于临床实践。减少阿片类药物使用和无阿片类药物的麻醉技术不仅是一种可能性，而且已成为现实。神经生物学和成瘾遗传学的持续研究最终将导致对有新的持续性阿片类药物滥用风险的患者采用药物遗传学方法。
