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Published in: Current Anesthesiology Reports 4/2023

13-11-2023 | Opioids | Anesthesia, Pain Management and Long-term Outcomes (VNR Gottumukkala and ER Mariano, Section Editors)

Perioperative Opioid Management Strategies: Do They Make a Difference in Long-Term Health Outcomes?

Authors: Ying Ye, Gabrielle Li, Edward R. Mariano

Published in: Current Anesthesiology Reports | Issue 4/2023

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Abstract

Purpose of Review

With the ongoing opioid epidemic, efforts have been made to limit opioid overprescribing and prevent misuse. This review looks at long-term outcomes of opioid management strategies.

Recent Findings

Approaches to opioid management in the perioperative phase include implementation of opioid stewardship programs, use of regional anesthesia techniques, addition of non-opioid analgesics, and adoption of enhanced recovery protocols. While the effects of these strategies on short-term outcomes have been extensively studied and reported, less is known about long-term health outcomes. To date, few studies have even collected data on potential long-term outcomes, and results are mixed regarding benefit with some studies showing equivocal outcomes.

Summary

While long-term health benefits have not been proven conclusively, there is sufficient evidence of short-term benefit to justify various opioid management strategies for surgical patients. The chronification of acute pain and opioid use after surgery typically occur during the subacute period after surgery, when patients are typically at home. A transitional pain service may help bridge the multiple services involved in perioperative pain management and provide the necessary surveillance and timely intervention that at-risk patients may need to prevent chronic pain and long-term opioid use.
Literature
6.
go back to reference Hyland SJ, Brockhaus KK, Vincent WR, Spence NZ, Lucki MM, Howkins MJ, et al. Perioperative pain management and opioid stewardship: a practical guide. Healthcare. 2021;9:333.CrossRefPubMedPubMedCentral Hyland SJ, Brockhaus KK, Vincent WR, Spence NZ, Lucki MM, Howkins MJ, et al. Perioperative pain management and opioid stewardship: a practical guide. Healthcare. 2021;9:333.CrossRefPubMedPubMedCentral
12.
go back to reference Tamboli M, Mariano ER, Gustafson KE, Briones BL, Hunter OO, Wang RR, et al. A multidisciplinary patient-specific opioid prescribing and tapering protocol is associated with a decrease in total opioid dose prescribed for six weeks after total hip arthroplasty. Pain Med Malden Mass. 2020;21:1474–81. https://doi.org/10.1093/pm/pnz260.CrossRef Tamboli M, Mariano ER, Gustafson KE, Briones BL, Hunter OO, Wang RR, et al. A multidisciplinary patient-specific opioid prescribing and tapering protocol is associated with a decrease in total opioid dose prescribed for six weeks after total hip arthroplasty. Pain Med Malden Mass. 2020;21:1474–81. https://​doi.​org/​10.​1093/​pm/​pnz260.CrossRef
18.•
go back to reference Mariano ER, Dickerson DM, Szokol JW, Harned M, Mueller JT, Philip BK, et al. A multisociety organizational consensus process to define guiding principles for acute perioperative pain management. Reg Anesth Pain Med. 2022;47:118–27. https://doi.org/10.1136/rapm-2021-103083. This consensus project involved 14 medical societies including the American Society of Anesthesiologists, American Medical Association, American Hospital Association, American College of Surgeons, and multiple subspecialty surgical organizations. The resulting principles are intended to guide acute perioperative pain management for all surgical patients.CrossRefPubMed Mariano ER, Dickerson DM, Szokol JW, Harned M, Mueller JT, Philip BK, et al. A multisociety organizational consensus process to define guiding principles for acute perioperative pain management. Reg Anesth Pain Med. 2022;47:118–27. https://​doi.​org/​10.​1136/​rapm-2021-103083. This consensus project involved 14 medical societies including the American Society of Anesthesiologists, American Medical Association, American Hospital Association, American College of Surgeons, and multiple subspecialty surgical organizations. The resulting principles are intended to guide acute perioperative pain management for all surgical patients.CrossRefPubMed
30.•
go back to reference Vasilopoulos T, Wardhan R, Rashidi P, Fillingim RB, Wallace MR, Crispen PL, et al. Patient and procedural determinants of postoperative pain trajectories. Anesthesiology. 2021;134:421–34. https://doi.org/10.1097/ALN.0000000000003681. This study using clinical data from patients at one academic medical center across a range of surgeries identifies five separate postoperative pain trajectories and a limited number of factors associated with trajectory assignment.CrossRefPubMed Vasilopoulos T, Wardhan R, Rashidi P, Fillingim RB, Wallace MR, Crispen PL, et al. Patient and procedural determinants of postoperative pain trajectories. Anesthesiology. 2021;134:421–34. https://​doi.​org/​10.​1097/​ALN.​0000000000003681​. This study using clinical data from patients at one academic medical center across a range of surgeries identifies five separate postoperative pain trajectories and a limited number of factors associated with trajectory assignment.CrossRefPubMed
39.
go back to reference Peng L, Ren L, Qin P, Chen J, Feng P, Lin H, et al. Continuous femoral nerve block versus intravenous patient controlled analgesia for knee mobility and long-term pain in patients receiving total knee replacement: a randomized controlled trial. Evid-Based Complement Altern Med ECAM. 2014;2014:569107. https://doi.org/10.1155/2014/569107.CrossRef Peng L, Ren L, Qin P, Chen J, Feng P, Lin H, et al. Continuous femoral nerve block versus intravenous patient controlled analgesia for knee mobility and long-term pain in patients receiving total knee replacement: a randomized controlled trial. Evid-Based Complement Altern Med ECAM. 2014;2014:569107. https://​doi.​org/​10.​1155/​2014/​569107.CrossRef
40.
go back to reference Wegener JT, van Ooij B, van Dijk CN, Karayeva SA, Hollmann MW, Preckel B, et al. Long-term pain and functional disability after total knee arthroplasty with and without single-injection or continuous sciatic nerve block in addition to continuous femoral nerve block: a prospective, 1-year follow-up of a randomized controlled trial. Reg Anesth Pain Med. 2013;38:58–63. https://doi.org/10.1097/AAP.0b013e318272523c.CrossRefPubMed Wegener JT, van Ooij B, van Dijk CN, Karayeva SA, Hollmann MW, Preckel B, et al. Long-term pain and functional disability after total knee arthroplasty with and without single-injection or continuous sciatic nerve block in addition to continuous femoral nerve block: a prospective, 1-year follow-up of a randomized controlled trial. Reg Anesth Pain Med. 2013;38:58–63. https://​doi.​org/​10.​1097/​AAP.​0b013e318272523c​.CrossRefPubMed
46.
go back to reference Memtsoudis SG, Cozowicz C, Bekeris J, Bekere D, Liu J, Soffin EM, et al. Peripheral nerve block anesthesia/analgesia for patients undergoing primary hip and knee arthroplasty: recommendations from the International Consensus on Anesthesia-Related Outcomes after Surgery (ICAROS) group based on a systematic review and meta-analysis of current literature. Reg Anesth Pain Med. 2021;46:971–85. https://doi.org/10.1136/rapm-2021-102750.CrossRefPubMed Memtsoudis SG, Cozowicz C, Bekeris J, Bekere D, Liu J, Soffin EM, et al. Peripheral nerve block anesthesia/analgesia for patients undergoing primary hip and knee arthroplasty: recommendations from the International Consensus on Anesthesia-Related Outcomes after Surgery (ICAROS) group based on a systematic review and meta-analysis of current literature. Reg Anesth Pain Med. 2021;46:971–85. https://​doi.​org/​10.​1136/​rapm-2021-102750.CrossRefPubMed
Metadata
Title
Perioperative Opioid Management Strategies: Do They Make a Difference in Long-Term Health Outcomes?
Authors
Ying Ye
Gabrielle Li
Edward R. Mariano
Publication date
13-11-2023
Publisher
Springer US
Published in
Current Anesthesiology Reports / Issue 4/2023
Electronic ISSN: 2167-6275
DOI
https://doi.org/10.1007/s40140-023-00589-7

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