2021年ACOG关于产后阶梯式多模式药物镇痛的建议及要点解读

产后疼痛是困扰产妇的常见问题,如治疗不当可能会导致阿片类药物滥用、产后抑郁和疼痛长期存在等不良后果。因此,美国妇产科医师学会（American College of Obstetricians and Gynecologists,ACOG）于2021年9月提出了针对产后疼痛的临床共识,专门对产后疼痛的一般管理、阴道分娩、剖宫产术后、母乳喂养时及出院后疼痛的处置给出了治疗建议与指导,强调了阶梯式多模式药物镇痛方法与个体化用药原则。推荐临床用药可遵循“非阿片类镇痛药（如对乙酰氨基酚和非甾体抗炎药）—弱阿片类药物—强阿片类药物（必要时）”阶梯式给药原则,并可合理联合用药。对此进行简要介绍与要点解读。

Interpretation of "2021 ACOG Clinical Consensus: Pharmacologic Stepwise Multimodal Approach for Postpartum Pain Management"

Postpartum pain is a common problem for pregnant women. Improper treatment may lead to adverse consequences such as greater opioid use, postpartum depression, and development of persistent pain. Therefore, ACOG put forward clinical consensus about the recommendations on pharmacologic stepwise multimodal approach for postpartum pain management in 2021, especially for acute perineal, uterine and incisional pain. In addition, it also provides advices for the treatment of postpartum pain when breastfeeding or discharge, and emphasizes the principle of individualized medication. The recommended clinical medication can follow the step-by-step administration of "non-opioid analgesics (such as acetaminophen and non-steroidal anti-inflammatory drugs) - weak opioids - strong opioids (if necessary)". Those can be combined reasonably. We tried to interpreted the main viewpoints of this clinical consensus in this review.