Page 17 - CASA Bulletin 2019 Vol 6 No 4

Vol.6, No.4, 2019

下文是美国华人麻醉学会（CASA）微信群对围术期阿片药物使用的问题导向性学习
与讨论摘要。

Question 1: Is narcotic usage in anesthesia by anesthesiologists a contributory to postop-

erative addiction? If so, how much narcotics should be used to avoid a possible addition?
Surgeon’s prescription is a different story though. (Jack Zhang, M.D., PhD, Sisters of Chari-

ty Hospital, Buffalo, NY:

Discussion 1: Although the intraoperative use of narcotics has not played a major role in the de-

velopment of current “opioid crisis”, there are plenty of data suggesting that the liberal use of
narcotics in the intraoperative period is unnecessary and that introspective narcotics will reset

the threshold for pain and tolerance. Therefore, many anesthesiologists are thinking how to re-

duce the use of narcotics in the postoperative period by introducing the opioid-free technique in
the intraoperative period.

Having said that, pain specialists, a group of anesthesiologists, have something to do with the

current opioid crisis. Many good intentions have turned into bad outcomes. (Victor W. Xia, M.D.,

Clinical Professor, UCLA Medical Center )

Question 2: Good question! I am curious too! How is everybody practice now? Avoid in-
tra-op Narcotic use? Some PACU RN told me: they have to give a lot of narcotics for those

ERAS pts. What is you guys experience? ( Qin Wang, M.D., AtlantiCare, Atlantic City, NJ)

Discussion 2: Narcotics is still analgesics of gold standard in anesthesia, no other complete re-

placement so far in my humble opinion. (Jack Zhang)

Question 3: What is the endpoint for narcotic role in optimization of pain control?

Are we going to the other extreme by withholding narcotic use for the fear of addiction?
(Jack Zhang)

Discussion 3.1: If we give patient GA without regional such as NB, epidural or spinal, it would

be hard to control the pain without narcotics. Though we can give others like IV Tylenol and To-

radol, I think the combination with narcotic is still necessary. (Xiaoyan Zhang )

Discussion 3.2: We started TAP block for some abdominal and renal surgical pt and most pa-
tients felt pain control better than only narcotics. (Ning Miao)

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