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在全球阿片类药物滥用危机与加速康复外科(ERAS)理念深度融合的临床背景下，无阿片类药物麻醉(OFA)以其“非阿片多模式镇痛”的核心逻辑，成为突破传统阿片依赖麻醉困境的重要探索方向，其通过整合非阿片类药物、区域阻滞技术及非药物干预，在减少术后疼痛的同时，可显著降低呼吸抑制、肠梗阻、药物耐受等阿片相关不良反应，多项临床研究已初步证实其在微创手术、特殊人群中的可行性。然而，当前证据体系仍存在局限性：高质量随机对照试验(RCT)匮乏、非阿片药物相互作用风险不明、癌症疼痛管理适配性待验证，且临床个体化应用路径尚未清晰。未来需以高质量多中心RCT为核心补全证据链，明确非阿片药物最佳组合与剂量阈值，同时针对特殊人群制定个体化方案，并推动技术协同应用以拓展适用场景，最终为ERAS理念落地提供规范、安全的麻醉支撑，为优化OFA临床决策路径奠定基础。
Abstract：Against the clinical backdrop of the global opioid abuse crisis deeply integrated with the concept of enhanced recovery after surgery(ERAS),opioid-free anesthesia(OFA),with its core logic of "non-opioid multimodal analgesia, " has become an important exploratory direction to break through the limitations of traditional opioid-dependent anesthesia. By integrating non-opioid drugs, regional block techniques, and pharmacological interventions, OFA aims to reduce postoperative pain while significantly decreasing opioid-related adverse effects such as respiratory depression, ileus, and drug tolerance. Multiple clinical studies have preliminarily confirmed its feasibility in minimally invasive surgeries and specific patient populations. However, the current evidence base has limitations: a lack of high-quality randomized controlled trials(RCTs),unclear risks of interactions among non-opioid drugs, unverified suitability for cancer pain management, and a lack of clear clinical pathways for individualized application. Future efforts must focus on completing the evidence chain with high-quality, multi-center RCTs, clarifying optimal drug combinations and dosage thresholds for non-opioid agents, developing individualized protocols for special populations, and promoting the synergistic application of techniques to expand applicable scenarios. This will ultimately provide standardized and safe anesthesia support for the implementation of the ERAS concept and lay the foundation for optimizing clinical decision-making pathways for OFA.
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基本信息:
中图分类号:R614
引用信息:
[1]姜雨鸽,马智慧,王颖莹.无阿片类药物全身麻醉：突破与局限并存的麻醉新范式[J].中华保健医学杂志,2026,28(04):307-311.
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