Chronic Opioid Use After Surgery: Implications for Perioperative Management in the Face of the Opioid Epidemic.
Chronic Opioid Use After Surgery: Implications for Perioperative Management in the Face of the Opioid Epidemic.
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DOI：
10.1213/ane.0000000000002458
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发表时间：
2017-11
影响因子：
5.7
通讯作者：
Sun E
中科院分区：
文献类型：
--
作者：
Hah JM;Bateman BT;Ratliff J;Curtin C;Sun E
医生、政策制定者和研究人员越来越关注如何减少美国阿片类药物的使用和过量，这两种情况在过去十年中急剧增加。虽然许多努力都集中在慢性疼痛的管理上，但在手术患者中使用阿片类药物提出了一个特别具有挑战性的问题，要求临床医生平衡两个相互竞争的利益：管理术后立即的急性疼痛和尽量减少术后持续使用阿片类药物的风险。鉴于越来越多的文献表明术后患者长期使用阿片类药物的风险增加，寻找尽量减少这种风险的方法尤为重要。包括外科医生和麻醉师在内的围手术期护理团队准备开发临床和基于系统的干预措施，旨在在术后立即缓解疼痛，同时降低长期使用阿片类药物的风险。在本文中，我们讨论了手术后长期使用阿片类药物的后果，并分析了手术与慢性阿片类药物使用的相关程度。接下来我们讨论了与术后长期使用阿片类药物相关的风险因素，并分析了围手术期阿片类药物节约干预措施（例如神经阻滞）在多大程度上可以降低术后长期使用阿片类药物的风险。然后我们最后讨论未来的研究方向。
Physicians, policymakers, and researchers are increasingly focused on finding ways to decrease opioid use and overdose in the United States both of which have sharply increased over the past decade. While many efforts are focused on the management of chronic pain, the use of opioids in surgical patients presents a particularly challenging problem requiring clinicians to balance two competing interests: managing acute pain in the immediate postoperative period and minimizing the risks of persistent opioid use following the surgery. Finding ways to minimize this risk is particularly salient in light of a growing literature suggesting that post-surgical patients are at increased risk for chronic opioid use. The perioperative care team, including surgeons and anesthesiologists, is poised to develop clinical and systems-based interventions aimed at providing pain relief in the immediate postoperative period while also reducing the risks of opioid use longer term. In this paper, we discuss the consequences of chronic opioid use following surgery, and present an analysis of the extent to which surgery has been associated with chronic opioid use. We follow with a discussion of the risk factors that are associated with chronic opioid use after surgery, and proceed with an analysis of the extent to which opioid sparing perioperative interventions (e.g., nerve blockade) have been shown to reduce the risk of chronic opioid use following surgery. We then conclude with a discussion of future research directions.