Management of Postoperative Pain: A Clinical Practice Guideline From the American Pain Society, the American Society of Regional Anesthesia and Pain Medicine, and the American Society of Anesthesiologists' Committee on Regional Anesthesia, Executive Committee, and Administrative Council

JOURNAL OF PAIN

卷:17

Article

Chou, Roger^1,2  Gordon, Debra B.³  de Leon-Casasola, Oscar A.^4,5  Rosenberg, Jack M.^6,7,8  Bickler, Stephen⁹  Brennan, Tim¹⁰  Carter, Todd¹¹  Cassidy, Carla L.¹²  Chittenden, Eva Hall¹³  Degenhardt, Ernest¹⁴  Griffith, Scott¹⁵  Manworren, Renee¹⁶  McCarberg, Bill¹⁷  Montgomery, Robert¹⁸  Murphy, Jamie¹⁹  Perkal, Melissa F.²⁰  Suresh, Santhanam²¹  Sluka, Kathleen²²  Strassels, Scott²³  Thirlby, Richard²⁴  Viscusi, Eugene²⁵  Walco, Gary A.²⁶  Warner, Lisa²⁷  Weisman, Steven J.²⁸  Wu, Christopher L.¹⁹ 

[1] Oregon Hlth & Sci Univ, Pacific Northwest Evidence Based Practice Ctr, Dept Med, Portland, OR 97201 USA

[2] Oregon Hlth & Sci Univ, Pacific Northwest Evidence Based Practice Ctr, Dept Med Informat & Clin Epidemiol, Portland, OR 97201 USA

[3] Univ Washington, Dept Anesthesiol & Pain Med, Seattle, WA 98195 USA

[4] Roswell Pk Canc Inst, Dept Anesthesiol & Pain Med, Buffalo, NY 14263 USA

[5] SUNY Buffalo, Sch Med & Biomed Sci, Buffalo, NY 14260 USA

[6] Univ Michigan, Vet Integrated Serv Network, Dept Vet Affairs, Ann Arbor, MI 48109 USA

[7] Univ Michigan, Dept Phys Med, Ann Arbor, MI 48109 USA

[8] Univ Michigan, Dept Rehabil & Anesthesiol, Ann Arbor, MI 48109 USA

[9] Univ Calif San Diego, Pediat Surg, San Diego, CA 92103 USA

[10] Univ Iowa Hosp & Clin, Dept Anesthesia, Iowa City, IA 52242 USA

[11] Univ Cincinnati, Dept Anesthesia, Cincinnati, OH USA

[12] Vet Hlth Adm, Dept Vet Affairs, Washington, DC USA

[13] Massachusetts Gen Hosp, Dept Palliat Care, Boston, MA 02114 USA

[14] United States Army Med Command, Qual Management Div, San Antonio, TX USA

[15] Walter Reed Army Med Ctr, Crit Care Med, Bethesda, MD USA

[16] Univ Connecticut, Sch Med, Dept Pediat, Mansfield, CT USA

[17] Amer Acad Pain Med, San Diego, CA USA

[18] Univ Colorado, Dept Anesthesiol, Denver, CO 80202 USA

[19] Johns Hopkins Univ, Dept Anesthesiol & Crit Care Med, Baltimore, MD USA

[20] Vet Affairs Med Ctr, Dept Surg, West Haven, CT USA

[21] Childrens Hosp Chicago, Dept Pediat Anesthesia, Chicago, IL USA

[22] Univ Iowa, Dept Phys Therapy & Rehabil, Iowa City, IA USA

[23] Univ Texas Austin, Coll Pharm, Austin, TX 78712 USA

[24] Virginia Mason Med Ctr, Bariatr Weight Loss Surg Ctr, Seattle, WA 98101 USA

[25] Thomas Jefferson Univ, Dept Anesthesiol, Philadelphia, PA 19107 USA

[26] Seattle Childrens Hosp, Dept Anesthesiol & Pain Med, Seattle, WA USA

[27] Dept Veteran Affairs, Phoenix, AZ USA

[28] Childrens Hosp Wisconsin, Dept Anesthesiol, Wauwatosa, WI USA

关键词: Postoperative pain management;    clinical practice guidelines;    analgesia;    education;    multi-modal therapy;    patient assessment;    regional analgesia;    neuraxial analgesia;   

DOI  :  10.1016/j.jpain.2015.12.008

来源: Elsevier

【 摘 要 】

Most patients who undergo surgical procedures experience acute postoperative pain, but evidence suggests that less than half report adequate postoperative pain relief. Many preoperative, intra-operative, 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 multi modal 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. (C) 2016 by the American Pain Society

【 授权许可】

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