The challenge of perioperative pain management in opioid-tolerant patients

被引：97

作者：

Coluzzi, Flaminia ^{[1
]}

Bifulco, Francesca ^{[2
]}

Cuomo, Arturo ^{[2
]}

Dauri, Mario ^{[3
]}

Leonardi, Claudio ^{[4
]}

Melotti, Rita Maria ^{[5
]}

Natoli, Silvia ^{[3
]}

Romualdi, Patrizia ^{[6
]}

Savoia, Gennaro ^{[7
]}

Corcione, Antonio ^{[8
]}

机构：

[1] Sapienza Univ Rome, Unit Anaesthesia Intens Care & Pain Med, Dept Med & Surg Sci & Biotechnol, Corso Repubbl 79, I-04100 Latina, Italy

[2] Natl Canc Inst, G Pascale Fdn, Unit Anaesthesia Intens Care & Pain Med, Naples, Italy

[3] Tor Vergata Univ Rome, Dept Clin Sci & Translat Med, Rome, Italy

[4] Local Hlth Unit ASL Rome 2, Addict Dis Dept, Rome, Italy

[5] Univ Bologna, Alma Mater Studiorum, Dept Med & Surg Sci, Bologna, Italy

[6] Univ Bologna, Alma Mater Studiorum, Dept Pharm & Biotechnol, Bologna, Italy

[7] Fatebenefratelli Hosp, Dept Anesthesia, Naples, Italy

[8] Dei Colli Hosp, Unit Anaesthesia & Intens Care, Naples, Italy

来源：

THERAPEUTICS AND CLINICAL RISK MANAGEMENT | 2017年 / 13卷

关键词：

opioids; postoperative pain; addiction; abusers; buprenorphine; methadone; POSTOPERATIVE PAIN; AMERICAN-SOCIETY; METHADONE; MAINTENANCE; ANALGESIA; CANCER; CARE; BUPRENORPHINE; MEDICATIONS; GUIDELINE;

D O I：

10.2147/TCRM.S141332

中图分类号：

R19 [保健组织与事业（卫生事业管理）];

学科分类号：

摘要：

The increasing number of opioid users among chronic pain patients, and opioid abusers among the general population, makes perioperative pain management challenging for health care professionals. Anesthesiologists, surgeons, and nurses should be familiar with some pharmacological phenomena which are typical of opioid users and abusers, such as tolerance, physical dependence, hyperalgesia, and addiction. Inadequate pain management is very common in these patients, due to common prejudices and fears. The target of preoperative evaluation is to identify comorbidities and risk factors and recognize signs and symptoms of opioid abuse and opioid withdrawal. Clinicians are encouraged to plan perioperative pain medications and to refer these patients to psychiatrists and addiction specialists for their evaluation. The aim of this review was to give practical suggestions for perioperative management of surgical opioidtolerant patients, together with schemes of opioid conversion for chronic pain patients assuming oral or transdermal opioids, and patients under maintenance programs with methadone, buprenorphine, or naltrexone.

引用

页码：1163 / 1173

页数：11

共 62 条

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