Abstract：
The American Academy of Orthopaedic Surgeons Clinical Practice Guideline \"Pharmacologic, Physical, and Cognitive Pain Alleviation for Musculoskeletal Extremity/Pelvis Surgery\" is a summary of the available literature designed to help guide surgeons provide a safe and effective means of pain alleviation for orthopaedic surgery patients. The following case study demonstrates these guidelines at work in a patient undergoing total shoulder arthroplasty. The recommendations listed in the following sentences are from the Clinical Practice Guideline. Preoperative patient education regarding the effects of opioids and benefits of early termination may help patients discontinue opioids earlier in their postoperative course. Perioperative use of intravenous ketamine and regional anesthesia continuous peripheral nerve catheters help reduce pain scores and decrease opioid use. Postoperative cryotherapy may provide a modest benefit in reducing pain scores. Postoperative cyclooxygenase-2 selective nonsteroidal anti-inflammatory medications (NSAIDs) and oral acetaminophen improve pain and decrease opioid use. Combination opioid/NSAIDs may provide a modest improvement in pain scores at the expense of NSAID dose optimization in the postoperative period. Gabapentin has not been shown to improve patient outcomes; however, pregabalin may decrease pain and opioid use after total joint arthroplasty.
摘要：
美国骨科医师学会临床实践指南“药理学，Physical,肌肉骨骼四肢/骨盆手术的认知疼痛缓解“是对现有文献的总结，旨在帮助指导外科医生为骨科手术患者提供安全有效的疼痛缓解手段。以下案例研究证明了这些指南在接受全肩关节置换术的患者中起作用。以下句子中列出的建议来自临床实践指南。关于阿片类药物的影响和早期终止的益处的术前患者教育可能有助于患者在术后早期停止阿片类药物。围手术期使用静脉氯胺酮和区域麻醉连续周围神经导管有助于减少疼痛评分并减少阿片类药物的使用。术后冷冻疗法可以在降低疼痛评分方面提供适度的益处。术后环氧合酶-2选择性非甾体抗炎药（NSAIDs）和口服对乙酰氨基酚可改善疼痛并减少阿片类药物的使用。组合阿片样物质/NSAID可以在术后期间以NSAID剂量优化为代价提供疼痛评分的适度改善。加巴喷丁没有被证明可以改善患者的预后；然而，普瑞巴林可减少全关节置换术后疼痛和阿片类药物的使用.
