Perioperative and Periprocedural anesthetic management of opioid tolerant patients and patients with active and medically treated opioid use disorder.
Perioperative and Periprocedural anesthetic management of opioid tolerant patients and patients with active and medically treated opioid use disorder.
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DOI：
10.1097/aco.0000000000001157
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发表时间：
2022-08-01
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阿片类药物耐受个体的患病率不断增加，加上非手术室麻醉（诺拉）的范围和使用不断扩大，因此有必要对该人群中管理手术/手术疼痛的最佳临床实践进行持续研究。本文的目的是回顾最近的指南，挑战和考虑管理阿片类药物耐受继发于阿片类药物使用障碍（OUD）的患者的疼痛，有或没有治疗阿片类药物使用障碍（MOUD）的药物。综合术前评估结合多学科、多模式疼痛方法是最佳的。诺拉增加了独特的情境和环境挑战，以优化耐受个体的急性慢性疼痛控制，同时保持安全性。直接和部分/混合μ受体激动剂通常应在整个围手术期持续使用，而μ受体拮抗剂（纳洛酮）应保持72小时。必须仔细安排并确保术后出院指导和随访。随着新的共识指南的发布，临床建议继续发展，尽管最常遵循的是机构特定的指南。本文综述了诺拉和手术室环境中管理阿片类药物耐受患者、OUD患者和MOUD患者的最新最佳实践。
The increasing prevalence of opioid tolerant individuals, in combination with the expanding scope and utilization of non-operating room anesthesia (NORA) necessitates ongoing investigation into best clinical practice for managing surgical/procedural pain in this population. The purpose of this article is to review recent guidelines, challenges, and considerations of managing pain in patients who are opioid tolerant secondary to opioid use disorder (OUD), with or without medications for the treatment of opioid use disorder (MOUD). A comprehensive preoperative evaluation in conjunction with a multidisciplinary, multimodal pain approach is optimal. NORA adds unique situational and environmental challenges for optimizing acute on chronic pain control in tolerant individuals while maintaining safety. Direct and partial/mixed mu-agonists should typically be continued throughout the perioperative period, while mu-antagonists (naltrexone) should be held 72 hours. Post procedural discharge instructions and follow up must be carefully arranged and ensured. Clinical recommendations continue to evolve as new consensus guidelines are published, although institution specific guidelines are most often followed. This review focuses on most recent best practices, within NORA and operating room settings, for managing opioid tolerant patients, patients with OUD and those on MOUD.