An international multidisciplinary consensus statement on the prevention of opioid-related harm in adult surgical patients

被引：126

作者：

Levy, N. ^{[1
]}

Quinlan, J. ^{[2
]}

El-Boghdadly, K. ^{[3
,4
]}

Fawcett, W. J. ^{[5
]}

Agarwal, V ^{[6
]}

Bastable, R. B. ^{[7
]}

Cox, F. J. ^{[8
]}

de Boer, H. D. ^{[9
]}

Dowdy, S. C. ^{[10
]}

Hattingh, K. ^{[11
]}

Knaggs, R. D. ^{[12
]}

Mariano, E. R. ^{[13
,14
]}

Pelosi, P. ^{[15
,16
]}

Scott, M. J. ^{[17
]}

Lobo, D. N. ^{[18
,19
,20
]}

Macintyre, P. E. ^{[21
,22
]}

机构：

[1] West Suffolk Hosp, Dept Anaesthesia & Peri Operat Med, Bury St Edmunds, Suffolk, England

[2] Oxford Univ Hosp NHS Fdn Trust, Nuffield Dept Anaesthet, Oxford, England

[3] Guys & St Thomas NHS Fdn Trust, Dept Anaesthesia, London, England

[4] Kings Coll London, London, England

[5] Royal Surrey Cty Hosp NHS Fdn Trust, Dept Anaesthesia & Pain Med, Guildford, Surrey, England

[6] Homi Bhabha Natl Inst, Tata Mem Ctr, Dept Anaesthesia Crit Care & Pain, Mumbai, Maharashtra, India

[7] Access Surg, Cambridge, England

[8] Royal Brompton & Harefield NHS Fdn Trust, Pain Management Serv Crit Care & Anaesthesia, London, England

[9] Martini Gen Hosp Groningen, Dept Anaesthesiol Pain Med & Procedural Sedat & A, Groningen, Netherlands

[10] Mayo Clin, Div Gynecol Oncol, Rochester, MN USA

[11] Bendigo Hlth, Victoria, Australia

[12] Univ Nottingham, Pain Ctr Versus Arthrit, Sch Pharm, Nottingham, England

[13] Stanford Univ, Dept Anesthesiol Peri Operat & Pain Med, Sch Med, Stanford, CA USA

[14] Vet Affairs Palo Alto Hlth Care Syst, Anesthesiol & Peri Operat Care Serv, Palo Alto, CA USA

[15] Univ Genoa, Dept Surg Sci & Integrated Diagnost, Genoa, Italy

[16] San Martino Policlin Hosp, IRCCS Oncol & Neurosci, Genoa, Italy

[17] Univ Penn, Anesthesiol & Crit Care Med, Perelman Sch Med, Philadelphia, PA 19104 USA

[18] Nottingham Univ Hosp NHS Trust, Nottingham Digest Dis Ctr, Gastrointestinal Surg, Natl Inst Hlth Res NIHR,Nottingham Biomed Res Ctr, Nottingham, England

[19] Univ Nottingham, Queens Med Ctr, Nottingham, England

[20] Univ Nottingham, MRC Versus Arthrit Ctr Musculoskeletal Ageing Res, David Greenfield Metab Physiol Unit, Sch Life Sci,Queens Med Ctr, Nottingham, England

[21] Royal Adelaide Hosp, Dept Anaesthesia Pain Med & Hyperbar Med, Adelaide, SA, Australia

[22] Univ Adelaide, Adelaide, SA, Australia

来源：

ANAESTHESIA | 2021年 / 76卷 / 04期

基金：

英国医学研究理事会;

关键词：

deprescribing; guidelines; opioid-induced ventilatory impairment; opioids; peri-operative; persistent postoperative opioid use; INDUCED RESPIRATORY DEPRESSION; PAIN MANAGEMENT; POSTOPERATIVE PAIN; NAIVE PATIENTS; PRESCRIPTION; DISCHARGE; SURGERY; RISK; IMPLEMENTATION; GUIDELINE;

D O I：

10.1111/anae.15262

中图分类号：

R614 [麻醉学];

学科分类号：

100217 ;

摘要：

This international multidisciplinary consensus statement was developed to provide balanced guidance on the safe peri-operative use of opioids in adults. An international panel of healthcare professionals evaluated the literature relating to postoperative opioid-related harm, including persistent postoperative opioid use; opioid-induced ventilatory impairment; non-medical opioid use; opioid diversion and dependence; and driving under the influence of prescription opioids. Recommended strategies to reduce harm include pre-operative assessment of the risk of persistent postoperative opioid use; use of an assessment of patient function rather than unidimensional pain scores alone to guide adequacy of analgesia; avoidance of long-acting (modified-release and transdermal patches) opioid formulations and combination analgesics; limiting the number of tablets prescribed at discharge; providing deprescribing advice; avoidance of automatic prescription refills; safe disposal of unused medicines; reducing the risk of opioid diversion; and better education of healthcare professionals, patients and carers. This consensus statement provides a framework for better prescribing practices that could help reduce the risk of postoperative opioid-related harm in adults.

引用

页码：520 / 536

页数：17

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