Impact of an Australian/New Zealand organisational position statement on extended‐release opioid prescribing among surgical inpatients: a dual centre before‐and‐after study

Awadalla, Rebecca; Liu, Shania; Kemp-Casey, Anna; Gnjidic, Danijela; Patanwala, Asad E.; Stevens, Jennifer A.; Begley, David; Bugeja, Bernadette; Penm, Jonathan

doi:10.1111/anae.15500

Cited by 14 publications

(29 citation statements)

References 20 publications

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Section: How Do We Implement the Most Modifiable Points In The Recent...mentioning

confidence: 99%

“…While this may be regarded as a draconian method to thwart the right of physicians to prescribe as they see fit, there has been a substantial lead time of physician education around this issue. The release of the ANZCA/FPM statement initiated and facilitated debate, which has been reflected in substantial changes to prescribing behaviour in hospitals, 50 while GP prescribing appears to be decreasing in metropolitan areas (Liu et al., submitted to Anaesthesia and Intensive Care ).…”

Section: Hospital Strategiesmentioning

confidence: 99%

“…49 Multiple studies demonstrate that the addition of SR opioids does nothing to improve analgesia but rather can contribute to harm because the overall total opioid dose increases with a predictable attendant increase in adverse events. 50 It can be challenging to understand how the addition of more opioids could not improve analgesia. The delivery of a background of continuous opioid and the accompanying increase in opioid load has seemed such a commonsense solution to severe postoperative pain that it has been adopted multiple times intravenously and orally over recent decades.…”

Section: Item 5: Long-acting Opioids Should Not Be Used Routinely For...mentioning

confidence: 99%

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How to close the gaps between evidence and practice for perioperative opioids

Stevens

Findlay

2022

Anaesth Intensive Care

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Excellent resources are now available that distil the best evidence around opioid prescribing in the perioperative period, including the list of recommendations provided by the international multidisciplinary consensus statement on the prevention of opioid-related harm in adult surgical patients. While some of the recommendations have been widely accepted as an essential part of postoperative practice, others have had slow and variable adoption. This article focuses on the items where theory and practice still diverge and suggests how best to close that gap. We must also remain mindful that while education is essential, it is on the lowest rung of implementation efficacy and, on its own, is a poor driver of behaviour change. Ongoing structural nudges and the use of local procedure-specific analgesic pathways will also be helpful in addressing the gap between evidence-based recommendations and practice.

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Section: How Do We Implement the Most Modifiable Points In The Recent...mentioning

confidence: 99%

Section: Hospital Strategiesmentioning

confidence: 99%

Section: Item 5: Long-acting Opioids Should Not Be Used Routinely For...mentioning

confidence: 99%

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How to close the gaps between evidence and practice for perioperative opioids

Stevens

Findlay

2022

Anaesth Intensive Care

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“…It is, therefore, welcome to read the paper by Awadalla et al. [12] published in this issue of Anaesthesia , in which they have sought to determine whether the publication of the ANZCA/FPM position statement [4] had an impact on the prescription of extended‐release opioids after surgery across two hospital systems in Sydney. The two hospitals did not alter their guidance and there were no academic detailing or audit and feedback activities as in the other opioid safety initiatives [13].…”

mentioning

confidence: 99%

“…While Awadalla et al [12] have demonstrated the impact of the ANZCA and its FPM position statement [4]…”

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confidence: 99%

De‐implementation of extended‐release opioids from peri‐operative pathways

2021

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Current Issues in the Use of Opioids for the Management of Postoperative Pain

et al. 2022

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ncontrolled and indiscriminate prescribing of opioids during the past 3 decades has led to an opioid crisis that started in North America and spread throughout high-income countries. [1][2][3][4][5] This crisis initially drew attention to inappropriate prescribing of opioids for the management of chronic noncancer pain. 3 This is pain that persists for more than 3 months, is not associated with tissue damage but rather a dysfunctional pain system, and for which opioids are not recommended. 5,6 In contrast, opioids remain an effective and important component of the management of acute postoperative pain, although it has recently become clear that excessive or prolonged prescribing of opioids for postoperative pain relief, both in hospital and after discharge, may also be playing a role in the crisis and increasing patient harms. 5 The genesis of this crisis is exemplified by the title of a 2018 article, "Good Intentions Gone Bad, an Industry Gone Rogue, and Watch Dogs Gone to Sleep." 2 The aim of this narrative review was to explore some of the current issues surrounding the use of opioids in the perioperative period, including the drivers that led to escalation of use; the resultant in-crease in patient harms, including opioid-induced ventilatory impairment (OIVI); the move away from using self-reported pain scores alone to assess adequacy of analgesia or to guide titration of opioids; concerns about the routine use of long-acting opioids including controlledrelease (also known as slow-, extended-, modified-, or sustainedrelease) formulations for the management of acute pain; and concerns about prescription of opioids on discharge from hospital. In addition, therehasbeenincreasingrecognitionthatpreadmissionlong-termopioid use can affect both short-term and long-term postoperative outcomes. Finally, this review addresses whether opioid-free anesthesia and analgesia (OFAA) might have a role to play in reducing postoperative opioid-related harms. MethodsWe searched the PubMed, Web of Science, Google Scholar, and Cochrane Library databases on June 8, 2021, using the terms opioid cri-IMPORTANCE Uncontrolled and indiscriminate prescribing of opioids has led to an opioid crisis that started in North America and spread throughout high-income countries. The aim of this narrative review was to explore some of the current issues surrounding the use of opioids in the perioperative period, focusing on drivers that led to escalation of use, patient harms, the move away from using self-reported pain scores alone to assess adequacy of analgesia, concerns about the routine use of controlled-release opioids for the management of acute pain, opioid-free anesthesia and analgesia, and prescription of opioids on discharge from hospital.OBSERVATIONS The origins of the opioid crisis are multifactorial and may include good intentions to keep patients pain free in the postoperative period. Assessment of patient function may be better than unidimensional numerical pain scores to help guide postoperative analgesia. Immediate-release opi...

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Impact of an Australian/New Zealand organisational position statement on extended‐release opioid prescribing among surgical inpatients: a dual centre before‐and‐after study

Cited by 14 publications

References 20 publications

How to close the gaps between evidence and practice for perioperative opioids

How to close the gaps between evidence and practice for perioperative opioids

De‐implementation of extended‐release opioids from peri‐operative pathways

Current Issues in the Use of Opioids for the Management of Postoperative Pain

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