Management of Postoperative Pain: A Clinical Practice Guideline From the American Pain Society, the American Society of Regional Anesthesia and Pain Medicine, and the American Society of Anesthesiologists' Committee on Regional Anesthesia, Executive Committee, and Administrative Council
Management of Postoperative Pain: A Clinical Practice Guideline From the American Pain Society, the American Society of Regional Anesthesia and Pain Medicine, and the American Society of Anesthesiologists' Committee on Regional Anesthesia, Executive Committee, and Administrative Council
复制标题
DOI：
10.1016/j.jpain.2015.12.008
复制
发表时间：
2016-02-01
期刊：
影响因子：
4
通讯作者：
Wu, Christopher L.
中科院分区：
文献类型：
--
作者：
Chou, Roger;Gordon, Debra B.;Wu, Christopher L.
大多数接受外科手术的患者都会经历急性术后疼痛，但有证据表明，不到一半的患者报告术后疼痛得到充分缓解。许多术前，术中和术后干预和管理策略可用于减少和管理术后疼痛。美国疼痛协会在美国麻醉医师协会的投入下，委托一个跨学科专家小组制定临床实践指南，以促进儿童和成人循证、有效和更安全的术后疼痛管理。该指南随后被美国区域麻醉协会批准。作为指南制定过程的一部分，对与术后疼痛的各种干预和管理策略相关的各个方面进行了系统性综述。在对证据进行审查后，专家小组制定了针对术后疼痛管理各个方面的建议，包括术前教育，围手术期疼痛管理计划，使用不同的药理学和非药理学方式，组织政策以及向门诊治疗的过渡。这些建议是基于这样一个基本前提，即最佳管理始于术前阶段，对患者进行评估，并制定针对个人和所涉及的外科手术的护理计划。专家组发现，有证据支持在许多情况下使用多模式方案，尽管有效的多模式护理的确切组成部分取决于患者、环境和外科手术。尽管这些指南是基于对术后疼痛管理证据的系统性回顾，但专家组发现了许多研究空白。在32项建议中，4项被评估为得到高质量证据的支持，11项（在患者教育和围手术期计划、患者评估、组织结构和政策以及向门诊治疗过渡等领域）是基于低质量证据提出的。(C)2016年美国疼痛协会American Pain Society
Most patients who undergo surgical procedures experience acute postoperative pain, but evidence suggests that less than half report adequate postoperative pain relief. Many preoperative, intra-operative, and postoperative interventions and management strategies are available for reducing and managing postoperative pain. The American Pain Society, with input from the American Society of Anesthesiologists, commissioned an interdisciplinary expert panel to develop a clinical practice guideline to promote evidence-based, effective, and safer postoperative pain management in children and adults. The guideline was subsequently approved by the American Society for Regional Anesthesia. As part of the guideline development process, a systematic review was commissioned on various aspects related to various interventions and management strategies for postoperative pain. After a review of the evidence, the expert panel formulated recommendations that addressed various aspects of postoperative pain management, including preoperative education, perioperative pain management planning, use of different pharmacological and nonpharmacological modalities, organizational policies, and transition to outpatient care. The recommendations are based on the underlying premise that optimal management begins in the preoperative period with an assessment of the patient and development of a plan of care tailored to the individual and the surgical procedure involved. The panel found that evidence supports the use of multimodal regimens in many situations, although the exact components of effective multi modal care will vary depending on the patient, setting, and surgical procedure. Although these guidelines are based on a systematic review of the evidence on management of postoperative pain, the panel identified numerous research gaps. Of 32 recommendations, 4 were assessed as being supported by high-quality evidence, and 11 (in the areas of patient education and perioperative planning, patient assessment, organizational structures and policies, and transitioning to outpatient care) were made on the basis of low-quality evidence. (C) 2016 by the American Pain Society