Osipova N A
Moscow Scientific Research Institute of Oncology of PA Gertsen, Department of Health and Medical Industry RF.
Anesteziol Reanimatol. 1996 Jul-Aug(4):17-21.
Presents a clinician's viewpoint on the tolerance of and dependence on opiates and opioids in total anesthesia and management of acute (postoperative) and chronic (cancer) pain. Clinical observations are assessed with due consideration for the theoretical (pharmacological) studies. The author analyzes prolonged therapy with different opiates and opioids and the short-term use in massive doses at different stages of surgery. Tolerance to morphine rapidly forms during therapy of chronic pain, and the narcotic doses have to be progressively increased. Tolerance to opioids, such as tramal and buprenorphine, is less expressed. These agents are less hazardous as regards drug dependence, which was proven for tramal by the naloxone test. Clinical manifestations of physical dependence on opiates at different stages of surgical treatment are discussed for the first time. The main last-generation opiates are characterized (tramal, buprenorphine, nalbufin, butorphanol, prosidol) by their capacity to cause physical and mental dependence. The author emphasizes the importance of a proper selection of opiates, opioids, and combinations thereof with the optimal nonopiate components in general anesthesia, postoperative analgesia, and treatment of chronic pain in order to improve the efficacy and narcological safety of analgesia.
本文呈现了临床医生对于在全身麻醉以及急性（术后）和慢性（癌症）疼痛管理中阿片类药物耐受性和依赖性的观点。在充分考虑理论（药理学）研究的基础上对临床观察结果进行了评估。作者分析了不同阿片类药物的长期治疗以及手术不同阶段大剂量的短期使用情况。在慢性疼痛治疗过程中，对吗啡的耐受性会迅速形成，必须逐渐增加麻醉剂量。对曲马多和丁丙诺啡等阿片类药物的耐受性则表现得没那么明显。就药物依赖性而言，这些药物危害较小，纳洛酮试验已证实曲马多确实如此。首次讨论了手术治疗不同阶段对阿片类药物身体依赖的临床表现。主要的新一代阿片类药物（曲马多、丁丙诺啡、纳布啡、布托啡诺、丙帕他莫）的特点是具有导致身体和精神依赖的能力。作者强调在全身麻醉、术后镇痛以及慢性疼痛治疗中，正确选择阿片类药物、阿片样物质及其与最佳非阿片类成分的组合对于提高镇痛效果和麻醉安全性的重要性。
