Purpose of Review

Effective acute pain management has evolved considerably in recent years and is a primary area of focus in attempts to defend against the opioid epidemic. Persistent postsurgical pain (PPP) has an incidence of up to 30–50% and has negative outcome of quality of life and negative burden on individuals, family, and society. The 2016 American Society of Anesthesiologists (ASA) guidelines states that enhanced recovery after surgery (ERAS) forms an integral part of Perioperative Surgical Home (PSH) and is now recommended to use a multimodal opioid-sparing approach for management of postoperative pain. As such, dexmedetomidine is now being used as part of ERAS protocols along with regional nerve blocks and other medications, to create a satisfactory postoperative outcome with reduced opioid consumption in the Post anesthesia care unit (PACU).

Recent Findings

Dexmedetomidine, a selective alpha₂ agonist, possesses analgesic effects and has a different mechanism of action when compared with opioids. When dexmedetomidine is initiated at the end of a procedure, it has a better hemodynamic stability and pain response than ropivacaine. Dexmedetomidine can be used as an adjuvant in epidurals with local anesthetic sparing effects. Its use during nerve blocks results in reduced postoperative pain. Also, local infiltration of IV dexmedetomidine is associated with earlier discharge from PACU.

Summary

Perioperative use of dexmedetomidine has significantly improved postoperative outcomes when used as part of ERAS protocols. An in-depth review of the use of dexmedetomidine in ERAS protocols is presented for clinical anesthesiologists.

中文翻译：

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右美托咪定在加速康复外科 (ERAS) 方案中用于治疗术后疼痛。

审查目的

近年来，有效的急性疼痛管理取得了长足的发展，并且成为预防阿片类药物流行的主要关注领域。持续性术后疼痛（PPP）的发生率高达 30-50%，对生活质量产生负面影响，并对个人、家庭和社会造成负面负担。2016 年美国麻醉医师协会 (ASA) 指南指出，加速康复外科 (ERAS) 是围术期手术之家 (PSH) 的一个组成部分，现在建议使用多模式阿片类药物保留方法来管理术后疼痛。因此，右美托咪定现在被用作 ERAS 方案的一部分，与区域神经阻滞和其他药物一起使用，以减少麻醉后护理室 (PACU) 中阿片类药物的消耗，从而创造令人满意的术后结果。

最近的发现

右美托咪定是一种选择性α2_激动剂，具有镇痛作用，与阿片类药物相比，其作用机制不同。当手术结束时开始使用右美托咪定时，它比罗哌卡因具有更好的血流动力学稳定性和疼痛反应。右美托咪定可用作硬膜外麻醉的佐剂，具有节省局麻药的作用。在神经阻滞过程中使用它可以减轻术后疼痛。此外，静脉注射右美托咪定的局部浸润与早期从 PACU 出院有关。

概括

作为 ERAS 方案的一部分，围手术期使用右美托咪定可显着改善术后结果。为临床麻醉师提供了关于 ERAS 方案中右美托咪定使用的深入回顾。