Department of Anesthesiology, Hsinchu Cathay General Hospital, Hsinchu, Taiwan.
Yuanpei University of Medical Technology, Hsinchu, Taiwan.
Asian J Anesthesiol. 2023 Sep 1;61(3):123-131. doi: 10.6859/aja.202309_61(3).0004.
The insufficient treatment of postoperative pain is considered a major barrier to enhanced patient recovery following surgery. Opioids remain the standard therapy for postoperative pain; however, the epidemic crisis of opioid abuse in the US has resulted in opioid-sparing multimodal analgesia (MMA) strategies in anesthesia practice. Complete perioperative pain management, particularly after discharge, may be undermined, resulting in chronic postsurgical pain. Thus, anesthesiologists and pain physicians should provide comprehensive MMA guidance for perioperative pain management.
The Taiwan Pain Society organized a working group, which included experts in the field of anesthesia, pain, and surgery. This group performed an extensive literature search, quality review, and drafted a consensus, which was discussed by experts and edited for feedback. Recommendations covered consent instruction, treatment interventions, intramuscular injection techniques, and prophylaxis for postoperative adverse events.
This consensus included (1) a comparison of the pharmacology and pharmacokinetics between nalbuphine and dinalbuphine sebacate, (2) recommendations to help clinicians establish MMA with extended-release dinalbuphine sebacate injection, and (3) management of common adverse events during the perioperative pain period.
Extended-release dinalbuphine sebacate combined with the MMA strategy can reduce the medical burden and improve the quality of recovery following surgery.
术后疼痛治疗不足被认为是促进术后患者康复的主要障碍。阿片类药物仍然是术后疼痛的标准治疗方法；然而，美国阿片类药物滥用的流行危机导致了麻醉实践中的阿片类药物节约型多模式镇痛（MMA）策略。完整的围手术期疼痛管理，特别是出院后，可能会受到影响，导致慢性术后疼痛。因此，麻醉师和疼痛医师应为围手术期疼痛管理提供全面的 MMA 指导。
台湾疼痛学会组织了一个工作组，其中包括麻醉、疼痛和外科领域的专家。该小组进行了广泛的文献检索、质量评估，并起草了共识，由专家讨论和编辑反馈。建议涵盖了知情同意书、治疗干预、肌内注射技术以及预防术后不良事件。
本共识包括：（1）纳布啡和丁丙诺啡癸酸酯的药理学和药代动力学比较；（2）帮助临床医生建立延长释放丁丙诺啡癸酸酯注射用 MMA 的建议；（3）围手术期疼痛期常见不良事件的管理。
延长释放丁丙诺啡癸酸酯联合 MMA 策略可以减轻医疗负担，提高术后恢复质量。
