Current Issues in the Use of Opioids for the Management of Postoperative Pain A Review

被引:71
作者
Macintyre, Pamela E. [1 ]
Quinlan, Jane [2 ]
Levy, Nicholas [3 ]
Lobo, Dileep N. [4 ,5 ,6 ]
机构
[1] Univ Adelaide, Adelaide Med Sch, Dept Anaesthesia Pain Med & Hyperbar Med, Royal Adelaide Hosp & Discipline Acute Care Med, Adelaide, SA, Australia
[2] Oxford Univ Hosp NHS Fdn Trust, Nuffield Dept Anaesthet, Oxford, England
[3] West Suffolk NHS Fdn Trust, Dept Anaesthesia & Perioperat Med, Bury St Edmunds, Suffolk, England
[4] Natl Inst Hlth Res NIHR, Gastrointestinal Surg, Nottingham Digest Dis Ctr, Nottingham Biomed Res Ctr,Nottingham Univ Hosp NH, Nottingham, England
[5] Univ Nottingham, Queens Med Ctr, Nottingham, England
[6] Univ Nottingham, Queens Med Ctr, MRC Versus Arthrit Ctr Musculoskeletal Ageing Res, Sch Life Sci, Nottingham, England
基金
英国医学研究理事会;
关键词
CONTROLLED-RELEASE OXYCODONE; RESPIRATORY DEPRESSION; PERIOPERATIVE USE; UNITED-STATES; SURGERY; PRESCRIPTION; MEDICINE; ANESTHESIA; STRATEGIES; GUIDELINES;
D O I
10.1001/jamasurg.2021.6210
中图分类号
R61 [外科手术学];
学科分类号
摘要
IMPORTANCE Uncontrolled and indiscriminate prescribing of opioids has led to an opioid crisis that started in North America and spread throughout high-income countries. The aim of this narrative review was to explore some of the current issues surrounding the use of opioids in the perioperative period, focusing on drivers that led to escalation of use, patient harms, the move away from using self-reported pain scores alone to assess adequacy of analgesia, concerns about the routine use of controlled-release opioids for the management of acute pain, opioid-free anesthesia and analgesia, and prescription of opioids on discharge from hospital. OBSERVATIONS The origins of the opioid crisis are multifactorial and may include good intentions to keep patients pain free in the postoperative period. Assessment of patient function may be better than unidimensional numerical pain scores to help guide postoperative analgesia. Immediate-release opioids can be titrated more easily to match analgesic requirements. There is currently no good evidence to show that opioid-free anesthesia and analgesia affects opioid prescribing practices or the risk of persistent postoperative opioid use. Attention should be paid to discharge opioid prescribing as repeat and refill prescriptions are risk-factors for persistent postoperative opioid use. Opioid stewardship is paramount, and many governments are passing legislation, while statutory bodies and professional societies are providing advice and guidance to help mitigate the harm caused by opioids. CONCLUSIONS AND RELEVANCE Opioids remain a crucial part of many patients' journey from surgery to full recovery. The last few decades have shown that unfettered opioid use puts patients and societies at risk, so caution is needed to mitigate those dangers. Opioid stewardship provides a multilayered structure to allow continued safe use of opioids as part of broad pain management strategies for those patients who benefit from them most.
引用
收藏
页码:158 / 166
页数:9
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