骨科患者的术后镇痛与患者的功能康复.ppt

*Opioidanalgesicsareassociatedwithsubstantialadverseeffectsthatlimittheirutilityinthehospitalandofficesettings.Themostdangerousisrespiratorydepression.Nausea,vomiting,andconstipationoccurfrequentlyandareoftenintolerable.1Althoughopioidanalgesicsareconsideredthegoldstandardinmanagingseverepain,theyareassociatedwithsubstantiallimitationsthatmayreducetheirutilityinpainmanagement.Respiratorydepressioncanoccurwithallcommonlyusedopioids.Thepotentialforrespiratorydepressionisveryrealandaclinicallyseriousrisk2Whileopioidsareconsideredeffectiveinmanagingseverepainwhilepatients areatrest,theyarethoughttobelessabletocontrolpainonmotion3?Chronicusemayleadtodevelopmentofphysicaldependenceandtolerance.Toleranceusuallydevelopstotheanalgesic,euphoric,andsedativeeffectsofopioids,butnottothepupillaryconstrictingandconstipatingeffects.Physicaldependencemayoccurwithinafewdaysofsustainedopioiduse.Abruptwithdrawalmayyieldunpleasanteffects1,2Opioidsgenerallyrequirespecifictrackinginthehospital,increasingbothcostsandtheadministrativeburdenTheadditionofnonopioidanalgesicscanimprovepaincontrolandminimizeadverseeffectswhiledecreasingtheneededdosageforopioids.3References:1.MorelandLW,St.ClairEW.Theuseofanalgesicsinthemanagementofpaininrheumaticdiseases.RheumDisClinNorthAm.1999;25:153-191.2.AtchesonR,RowbothamDJ.Pharmacologyofacuteandchronicpain.In:RawalN,ed.ManagementofAcuteandChronicPain.London,England:BMJBooks;1998:23-50.3.PowerI,BarrattS.Analgesicagentsforthepostoperativeperiod.Nonopioids.SurgClinNorthAm.1999;79:275-295.*ThemajorproblemwithuseofnonspecificNSAIDsistheoccurrenceofadverseevents,whichcanlimittheirutilizationinperioperativeanalgesia.Gastrointestinal:Gastropathyassociatedwiththeuseofboth