大多数接受外科手术的患者会经历急性术后疼痛,但证据表明,不到一半的人报告术后疼痛得到了充分缓解。许多术前,术中,术后干预措施和管理策略可用于减轻和管理术后疼痛。美国疼痛协会,根据美国麻醉师协会的意见,委托跨学科专家小组制定临床实践指南,以促进循证,有效,以及更安全的儿童和成人术后疼痛管理。该指南随后得到美国区域麻醉学会的批准。作为指导方针制定过程的一部分,我们委托对与术后疼痛的各种干预措施和管理策略相关的各个方面进行系统评价.在对证据进行审查后,专家小组提出了针对术后疼痛管理各个方面的建议,包括术前教育,围手术期疼痛管理计划,使用不同的药理学和非药理学方式,组织政策,过渡到门诊护理。建议基于以下基本前提:最佳管理在术前阶段开始,评估患者并制定针对个人和所涉及的外科手术的护理计划。小组发现,证据支持在许多情况下使用多式联运方案,尽管有效的多模式护理的确切组成部分因患者而异,设置,和外科手术。尽管这些指南是基于对术后疼痛管理证据的系统评价,小组发现了许多研究空白。在32项建议中,4人被评估为得到高质量证据的支持,和11(在患者教育和围手术期计划方面,患者评估,组织结构和政策,并过渡到门诊护理)是在低质量证据的基础上进行的。
结论:本指南,在对术后疼痛管理证据进行系统回顾的基础上,提供由多学科专家小组制定的建议。安全有效的术后疼痛管理应基于针对个人和所涉及的外科手术的护理计划,在许多情况下,建议使用多式联运方案。
Most patients who undergo surgical procedures experience acute postoperative pain, but evidence suggests that less than half report adequate postoperative pain relief. Many preoperative, intraoperative, and postoperative interventions and management strategies are available for reducing and managing postoperative pain. The American Pain Society, with input from the American Society of Anesthesiologists, commissioned an interdisciplinary expert panel to develop a clinical practice
guideline to promote evidence-based, effective, and safer postoperative pain management in children and adults. The
guideline was subsequently approved by the American Society for Regional Anesthesia. As part of the
guideline development process, a systematic review was commissioned on various aspects related to various interventions and management strategies for postoperative pain. After a review of the evidence, the expert panel formulated recommendations that addressed various aspects of postoperative pain management, including preoperative education, perioperative pain management planning, use of different pharmacological and nonpharmacological modalities, organizational policies, and transition to outpatient care. The recommendations are based on the underlying premise that optimal management begins in the preoperative period with an assessment of the patient and development of a plan of care tailored to the individual and the surgical procedure involved. The panel found that evidence supports the use of multimodal regimens in many situations, although the exact components of effective multimodal care will vary depending on the patient, setting, and surgical procedure. Although these
guidelines are based on a systematic review of the evidence on management of postoperative pain, the panel identified numerous research gaps. Of 32 recommendations, 4 were assessed as being supported by high-quality evidence, and 11 (in the areas of patient education and perioperative planning, patient assessment, organizational structures and policies, and transitioning to outpatient care) were made on the basis of low-quality evidence.
CONCLUSIONS: This
guideline, on the basis of a systematic review of the evidence on postoperative pain management, provides recommendations developed by a multidisciplinary expert panel. Safe and effective postoperative pain management should be on the basis of a plan of care tailored to the individual and the surgical procedure involved, and multimodal regimens are recommended in many situations.