Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Phoenix, Arizona.
Department of Anesthesiology, Moffitt Cancer Center, Tampa, Florida.
Curr Opin Anaesthesiol. 2024 Dec 1;37(6):697-704. doi: 10.1097/ACO.0000000000001426. Epub 2024 Aug 9.
Although necessary for treatment of acute pain, opioids are associated with significant harm in the perioperative period and further intervention is necessary perioperatively to mitigate opioid-related harm.
Opioid-naive patients are often first exposed to opioids when undergoing surgery, which can result in significant harm. Despite their benefits in reducing acute postsurgical pain, they are also associated with risks ranging from mild (e.g., pruritis, constipation, nausea) to potentially catastrophic (e.g. opioid-induced ventilatory impairment, respiratory depression, death). Overprescribing of opioids can lead to opioid diversion and drug driving. In this review, we will discuss opioid-related harm and what strategies can be used perioperatively to mitigate this harm. Interventions such as optimizing nonopioid analgesia, implementing Enhanced Recovery after Surgery programs, effective respiratory monitoring, patient education and opioid stewardship programs will be discussed.
We will review policy and guidelines regarding perioperative opioid management and identify challenges and future directions to mitigate opioid-related harm.
尽管阿片类药物是急性疼痛治疗所必需的，但它们与围手术期的显著危害相关，因此有必要在围手术期进行进一步干预以减轻阿片类药物相关危害。
阿片类药物初治患者在接受手术时通常首次接触阿片类药物，这可能会导致严重的伤害。尽管它们在减轻急性术后疼痛方面有一定的益处，但也存在从轻度（如瘙痒、便秘、恶心）到潜在灾难性（如阿片类药物引起的通气损害、呼吸抑制、死亡）的风险。阿片类药物的过度处方可导致阿片类药物的转移和药物驾驶。在这篇综述中，我们将讨论与阿片类药物相关的危害，以及可以在围手术期采取哪些策略来减轻这种危害。我们将讨论诸如优化非阿片类镇痛、实施手术后恢复增强计划、有效的呼吸监测、患者教育和阿片类药物管理计划等干预措施。
我们将回顾围手术期阿片类药物管理的政策和指南，并确定减轻阿片类药物相关危害的挑战和未来方向。
