背景:手术后急性疼痛控制不佳可促进长期使用阿片类药物和在初次手术后长期误用。增强手术后恢复(ERAS)指南已显示出减少阿片类药物暴露和减少阿片类药物相关副作用的希望。
目的:本循证实践(EBP)项目的目的是评估ERAS文献,以指导成人结直肠手术单位术后疼痛管理实践的改变,评估实践变化的结果,并传播调查结果。
方法:A人口,干预,比较,结果,建立了时间(PICOT)问题来指导ERAS文献检索。使用FULD关键评估工具对发现的文章进行了关键评估。在批判性评估之后,EBP的步骤被用于在281张病床的医疗中心为成人结直肠手术患者实施ERAS指南.通过比较多模式镇痛来评估实践变化的结果,区域麻醉,指南实施前后阿片类止痛药使用情况。
结果:对指南制定进行了严格评估。实施后,数据显示,多模式镇痛药和区域麻醉的使用增加,阿片类止痛药的使用减少.这些发现通过医院内的多个地点传播,包括向利益相关者的介绍。
结论:在减少围手术期阿片类药物用量的同时,可实现减少术后疼痛的循证策略。关键利益相关者的参与和EBP变更的及时推出对于成功实施至关重要。具有多模式镇痛途径的ERAS指南是减少术后疼痛和围手术期阿片类药物消耗的有效方法。
BACKGROUND: Poorly controlled acute postsurgical pain can promote chronic opioid use and misuse long after the initial surgical procedure. Enhanced recovery after surgery (ERAS)
guidelines have shown promise in reducing opioid exposure and minimizing opioid-related side effects.
OBJECTIVE: The aims of this evidence-based practice (EBP) project were to assess the ERAS literature to guide postoperative pain management practice change at an adult colorectal surgical unit, evaluate the practice change outcomes, and disseminate the findings.
METHODS: A Population, Intervention, Comparison, Outcome, and Time (PICOT) question was established to guide an ERAS literature search. Found articles were critically appraised using the FULD Critical Appraisal Tool. Following the critical appraisal, the steps of EBP were utilized to implement an ERAS
guideline for adult colorectal surgical patients in a 281-bed medical center. Outcomes of the practice change were evaluated by comparing multimodal analgesic, regional anesthesia, and opioid pain medication use before and after
guideline implementation.
RESULTS: Five articles were critically appraised for
guideline development. After implementation, data demonstrated an increase in the use of multimodal analgesics and regional anesthesia and a decrease in the use of opioid pain medication. These findings were disseminated through multiple venues within the hospital, including a presentation to the stakeholders.
CONCLUSIONS: Evidence-based strategies to reduce postoperative pain are achievable while reducing perioperative opioid consumption. Engagement of key stakeholders and timely rollout of EBP changes are important for successful implementation. ERAS
guidelines with a multimodal analgesia pathway are an effective way to reduce postoperative pain and perioperative opioid consumption.