Challenges in the Management of Acute Postsurgical Pain
Challenges in the Management of Acute Postsurgical Pain
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DOI：
10.1002/j.1875-9114.2012.01177.x
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发表时间：
2012-09-01
期刊：
影响因子：
4.1
通讯作者：
Oderda, Gary
中科院分区：
文献类型：
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作者：
Oderda, Gary
大多数接受手术的患者将需要药物治疗来控制急性术后疼痛。有效控制术后急性疼痛对患者不仅短期而且长期都是至关重要的，以防止早期急性疼痛延长可能发生的慢性疼痛的发展。目前，阿片类镇痛药被广泛用于急性术后疼痛的治疗。尽管阿片类药物可以有效缓解术后疼痛，但其使用与许多风险相关，包括阿片类药物相关不良事件（ORADEs）的发生。本综述调查了阿片类药物在术后使用的流行程度、ORADEs的发生率，以及这些ORADEs对普通手术后患者预后、住院时间和费用的影响。根据一项全国性的ORADE发生率分析，近20%接受阿片类药物治疗的患者发生了ORADE，最常见的是胃肠道反应、中枢神经系统反应、瘙痒或尿潴留。研究表明，与接受普通手术的患者相比，接受高剂量阿片类药物的患者和接受骨科或妇科手术的患者发生ORADE的风险更高。老年患者和有合并症（如肥胖、睡眠呼吸暂停、呼吸系统疾病、泌尿系统疾病）的患者可能特别容易发生ORADE。与未接受ORADE的患者相比，接受ORADE的患者的住院费用和住院时间都有所增加。减少手术后阿片类药物使用的策略可能会通过减少orade的发生率产生积极结果，从而降低与手术相关的治疗费用并改善患者护理。
The majority of patients who undergo surgery will require drug therapy for the management of acute postsurgical pain. Effective control of acute postsurgical pain is essential for the patient not only in the short term but also in the long term to prevent the development of chronic pain, which can occur if early acute pain is prolonged. Currently, opioid analgesics are widely used for the management of acute postsurgical pain. Although opioids provide effective postsurgical pain relief, their use is associated with a number of risks, including the development of opioid-related adverse drug events (ORADEs). This review investigates the prevalence of opioid use in the postsurgical setting, the incidence of ORADEs, and the impact of these ORADEs on patient outcomes, length of stay, and costs after common surgeries. According to a national analysis of ORADE incidence, almost 20% of patients treated with opioids experienced an ORADE, with the most common being gastrointestinal effects, central nervous system effects, pruritus, or urinary retention. Studies show that the risk of developing an ORADE is higher in patients receiving higher doses of opioids and in patients undergoing orthopedic or gynecologic surgery compared with patients undergoing general surgery. Elderly patients and those with comorbidities (e.g., obesity, sleep apnea, respiratory disease, urinary disorders) may be particularly vulnerable to ORADE development. Both hospital costs and length of stay are increased in patients with an ORADE versus those without an ORADE. Strategies to reduce the use of opioids after surgery are likely to result in positive outcomes by reducing the incidence of ORADEs and, as a result, reducing treatment costs associated with surgery and improving patient care.