骨科加速康复围手术期疼痛管理专家共识

Expert consensus on perioperative pain management in orthopaedics in enhanced recovery after surgery program

疼痛是第五大生命体征,也是骨科患者围手术期最重要的主诉之一,更是影响骨科患者术后功能康复的核心问题。如何对骨科手术患者进行有效的疼痛评估与管理是推动骨科加速康复的关键措施。为了规范骨科加速康复围手术期疼痛管理,减少围手术期疼痛相关并发症,提高医疗质量和安全,国家卫生健康委加速康复外科专家委员会骨科专家组、中国研究型医院学会骨科加速康复专业委员会、中国康复技术转化及促进会骨科加速康复专业委员会联合多学科专家成立骨科加速康复系列共识编写专家委员会,以临床问题为导向,遵循循证医学原则,归纳出7个方面的问题:(1)疼痛的分类;(2)围手术期疼痛管理的目的与原则;(3)入院前疼痛评估与管理;(4)术前疼痛管理;(5)术中疼痛管理;(6)麻醉恢复室疼痛管理;(7)术后疼痛管理。按照上述7个方面的问题进行文献检索与归纳,结合2019版《中国骨科手术加速康复围手术期疼痛管理指南》及近3年国内外最新研究进展,更加强调围手术期减少创伤性及炎症性疼痛、医学人文关怀和疼痛的流程管理。经过线上结合线下会议反复讨论和修改后形成本共识,期望其为我国骨科加速康复围手术期疼痛管理的多学科协作起到积极的推动作用,最终达到加速患者康复的目的。

Pain is the fifth vital sign,one of most important chief complaints of orthopaedic patients,and also a key issue for the postoperative functional rehabilitation.Effective assessment and management of pain for patients undergoing orthopaedic surgery is a key measure to accelerate the implementation of the pilot work of enhanced recovery after surgery.In order to standardize perioperative pain management,reduce perioperative pain related complications,and improve medical quality and safety,Orthopaedic Expert Group of ERAS profession Committee of National Health Commission,Orthopaedic ERAS profession Committee of Chinese Research Hospital Association,Orthopaedic ERAS profession Committee of China Association of Rehabilitation Technology Transformation and Promotion,together with experts from related disciplines,established a collaborative expert committee for this consensus writing.Focusing on the clinical problems and following evidence-based medicine principles,the experts summarized the following seven aspects:(1)classification of pain;(2)the purpose and principle of perioperative pain management;(3)evaluation and management of pain before admission;(4)perioperative pain management;(5)intraoperative pain management;(6)pain management in the post-anesthesia care unit;(7)postoperative pain management.Around these seven aspects,literature was searched and induced,and the latest researches of recent three years were referenced as well as the 2019 edition of Guideline on perioperative pain management for the enhanced recovery after orthopaedic surgery in China.Through repeated discussions online and offline together and revisions,this consensus was developed,which further underlined the elimination of harmful and inflammatory pain,medical humanistic care and pain management mode hoping to promote the multidisciplinary cooperation and realize rapid recovery for patients.