Optimizing Perioperative Use of Opioids: A Multimodal Approach.
Optimizing Perioperative Use of Opioids: A Multimodal Approach.
复制标题
优化阿片类药物的围手术期使用：一种多模式方法。
DOI：
10.1007/s40140-020-00413-6
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发表时间：
2020-12
影响因子：
1.3
通讯作者：
Cata JP
中科院分区：
文献类型：
--
作者：
Ramirez MF;Kamdar BB;Cata JP
本文的主要目的是回顾有关多模式镇痛药物的最新文献，引用其推荐剂量、疗效和副作用。本报告的第二部分将描述处于不同开发阶段的药物，这些药物具有新颖的机制，且副作用较少，例如耐受性和成瘾性。多模式镇痛是一种通过在可能的情况下采用两种或多种全身镇痛药以及局部麻醉来促进围手术期疼痛管理的技术。尽管阿片类药物和非阿片类镇痛药仍然是术后急性疼痛管理最常用的药物，但它们有许多不良副作用，包括可能被滥用。新型镇痛药包括外周作用阿片类药物、一氧化氮抑制剂、降钙素基因相关肽受体拮抗剂、白细胞介素6受体拮抗剂和基因疗法正在深入研究中。患者首次接触阿片类药物通常是在围手术期，这是一个脆弱的时期，多模式治疗可以在减少阿片类药物暴露方面发挥重要作用。此外，目前向更快恢复时间、更少术后并发症和提高围手术期成本效益的转变，使多模式镇痛成为加速康复外科 (ERAS) 方案的核心支柱。
The main purpose of this article is to review recent literature regarding multimodal analgesia medications, citing their recommended doses, efficacy, and side effects. The second part of this report will provide a description of drugs in different stages of development which have novel mechanisms with less side effects such as tolerance and addiction. Multimodal analgesia is a technique that facilitates perioperative pain management by employing two or more systemic analgesics along with regional anesthesia, when possible. Even though opioids and non-opioid analgesics remain the most common medication used for acute pain management after surgery, they have many undesirable side effects including the potential for misuse. Newer analgesics including peripheral acting opioids, nitric oxide inhibitors, calcitonin gene-related peptide receptor antagonists, interleukin-6 receptor antagonists and gene therapy are under intensive investigation. A patient’s first exposure to opioids is often in the perioperative setting, a vulnerable time when multimodal therapy can play a large role in decreasing opioid exposure. Additionally, the current shift towards faster recovery times, fewer post-operative complications and improved cost-effectiveness during the perioperative period has made multimodal analgesia a central pillar of Enhanced Recovery After Surgery (ERAS) protocols.