Abstract：
Background: Although opioids are used first line for cancer pain and commonly for complex noncancer pain, there are risks associated with their use and not effective for all types of pain. There\'s a need to identify and develop clinical practice guidelines for nonopioids for the treatment of refractory pain. Methods: Our study collected information from national clinical practice guidelines for ketamine, lidocaine, and dexmedetomidine with the aim to identify consensus among the different practices. Results: Fifteen institutions nationally participated in the study and only nine of those institutions had guidelines and were permitted by their health system to share them. Of the institutions that participated, 44% had guidelines for ketamine and lidocaine, and only two institutions (22%) had guidelines for ketamine, lidocaine, and dexmedetomidine for refractory pain. There were variations in restriction of the level of care and prescribers, dosing, and determination of efficacy. There were trends of consensus in monitoring for side effects. Conclusion: This study serves as a starting point for a snapshot of the use of ketamine, lidocaine, and dexmedetomidine for refractory pain, but further studies and increased participation of institutions are needed to develop consensus clinical practice guidelines.
摘要：
背景：尽管阿片类药物被用于癌症疼痛的一线治疗，通常用于复杂的非癌症疼痛，它们的使用存在风险，并且对所有类型的疼痛都无效。有必要确定和制定非阿片类药物治疗难治性疼痛的临床实践指南。方法：我们的研究从氯胺酮的国家临床实践指南中收集信息，利多卡因,和右美托咪定，目的是确定不同实践之间的共识。结果：全国有15个机构参与了这项研究，其中只有9个机构有指导方针，并被其卫生系统允许分享这些指导方针。在参与的机构中，44%的人有氯胺酮和利多卡因的指南，只有两家机构(22%)有氯胺酮指南，利多卡因,右美托咪定用于难治性疼痛。对护理水平和处方者的限制有所不同，给药,并确定疗效。在监测副作用方面存在共识趋势。结论：本研究作为氯胺酮使用快照的起点，利多卡因,右美托咪定用于难治性疼痛，但需要进一步的研究和更多机构的参与来制定一致的临床实践指南.
