Opioid abuse and perioperative care: a new medical disease

Abstract

Purpose of reviewThis review article aims to describe the perioperative clinical implications of opioid use or opioid use disorder (OUD) and to provide recommendations related to analgesia, anesthesia, and postoperative care for patients with this 'new medical disease'. Recent findingsEvidence suggest that 1 in 4 surgical patients will be using opioids preoperatively. Management of these patients, or those with OUD, can be challenging given their opioid tolerance, hyperalgesia, decreased pain tolerance, and increased pain sensitivity. Therefore, an individualized plan that considers how to manage OUD treatment medications, the risk of relapse, multimodal analgesia, and postoperative monitoring requirements is highly important. Fortunately, recent publications provide both insight and guidance on these topics. Postoperatively, persistent opioid utilization appears higher in patients currently using opioids and even for those with a prior history. Although numerous other adverse outcomes are also associated with opioid use or abuse, some may be modifiable with cessation. SummaryA coordinated, evidence-based, multidisciplinary team approach is critical when caring for patients with OUD to ensure safety, provide adequate analgesia, and reduce the risk of relapse. Enhanced postoperative monitoring, multimodal analgesia, and a plan for preoperative opioid management may help to modify the risks of adverse postoperative outcomes.

Pain treatment and prophylaxis on pain

“…the risk of postoperative pain is increased [18]. The regular use of preoperative painkillers will be an independent risk factor, especially if opioids are used preoperatively [19 ▪ ]. In general, young patients tend to have more pain than elderly [20 ▪ ], and females more than men.…”

“…[44,45]. However, the have a number of well known side-effects and especially hyperalgesia and the addiction potential are much in focus presently [2,19 ▪ ]. It has been shown that high-dose per-operative opioid may increase the risk of postoperative pain, and opioid-free anaesthesia has been suggested as a measure to reduce postoperative pain.…”

How to prevent opioid abuse and addiction

“…The authors also suggested that the preemptive visceral analgesic effect of pre-incisional TPVB should be studied for surgeries other than LC. Henshaw et al [ 9 ] argued that opioid abuse should be recognized as a new disease and suggested that enhanced postoperative monitoring, multimodal analgesia, and a plan for preoperative opioid management may help modify the risks of adverse postoperative outcomes. Thus, the need for anesthesiologists to join in the efforts to reduce opioid use during the perioperative period and take a lead in discovering new pain management methods is growing.…”

“…The authors also suggested that the preemptive visceral analgesic effect of pre-incisional TPVB should be studied for surgeries other than LC. Henshaw et al [9] argued that opioid abuse should be recognized as a new disease and suggested that enhanced postoperative monitoring, multimodal analgesia, and a plan for preoperative opi-…”