癌痛治疗中氢可酮和羟考酮怎么成了弱阿片类药了 - 新青年麻醉论坛

The use of oral analgesics is considered essential to management of cancer pain. In 1988 the WHO first promoted the Canadian three-step ladder for cancer pain management. It provides a template that can be used according to the severity of the patient’s pain.

Step 1 includes acetaminophen and NSAIDs. These are available without prescription and are used as first-line therapy for mild pain. Step 2 includes “weak” opioids available as combinations with acetaminophen or aspirin such as hydrocodone/acetaminophen and oxycodone/ acetaminophen, which have a ceiling amount due to the safe amount of acetaminophen that can be administered. Step 3 is used for severe pain or when the medications from Step 2 are ineffective in controlling pain. Step 3 includes fentanyl and hydromorphone. Interventions are not noted on the WHO ladder but are informally referenced as “Step 4.”