Opioid stewardship

Simpson, Andrew; Levy, N.; Mariano, Edward R.

doi:10.1016/j.bjae.2023.05.007

BJA Education

2023

DOI: 10.1016/j.bjae.2023.05.007

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Opioid stewardship

Andrew Simpson¹,

N. Levy²,

Edward R. Mariano³

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2024

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Cited by 3 publications

References 23 publications

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Current advances in the pain treatment and mechanisms of Traditional Chinese Medicine

Zhu,

Jia,

Zhou

et al. 2024

Phytotherapy Research

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Traditional Chinese Medicine (TCM), as a unique medical model in China, has been shown to be effective in the treatment of many diseases. It has been proven that TCM can increase the pain threshold, increase the level of endorphins and enkephalins in the body, and reduce the body's response to adverse stimuli. In recent years, TCM scholars have made valuable explorations in the field of pain treatment, using methods such as internal and external application of TCM and acupuncture to carry out research on pain treatment and have achieved more satisfactory results. TCM treats pain in a variety of ways, and with the discovery of a variety of potential bioactive substances for pain treatment. With the new progress in the research of other TCM treatment methods for pain, TCM will have greater potential in the clinical application of pain.

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Current advances in the pain treatment and mechanisms of Traditional Chinese Medicine

Zhu,

Jia,

Zhou

et al. 2024

Phytotherapy Research

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Mitigating and preventing perioperative opioid-related harm

Harbell,

Cohen,

Balfanz

et al. 2024

Current Opinion in Anaesthesiology

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Purpose of review Although necessary for treatment of acute pain, opioids are associated with significant harm in the perioperative period and further intervention is necessary perioperatively to mitigate opioid-related harm. Recent findings Opioid-naive patients are often first exposed to opioids when undergoing surgery, which can result in significant harm. Despite their benefits in reducing acute postsurgical pain, they are also associated with risks ranging from mild (e.g., pruritis, constipation, nausea) to potentially catastrophic (e.g. opioid-induced ventilatory impairment, respiratory depression, death). Overprescribing of opioids can lead to opioid diversion and drug driving. In this review, we will discuss opioid-related harm and what strategies can be used perioperatively to mitigate this harm. Interventions such as optimizing nonopioid analgesia, implementing Enhanced Recovery after Surgery programs, effective respiratory monitoring, patient education and opioid stewardship programs will be discussed. Summary We will review policy and guidelines regarding perioperative opioid management and identify challenges and future directions to mitigate opioid-related harm.

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A pilot multicentre randomised clinical trial to determine the effect of a pharmacist‐partnered opioid tapering intervention before total hip or knee arthroplasty

Liu,

Patanwala,

Stevens

et al. 2024

Anaesthesia

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SummaryBackgroundOpioid analgesic use before total hip or knee arthroplasty has been associated with worse postoperative outcomes. This pilot study aimed to examine the feasibility of a telehealth‐based pharmacist‐partnered opioid tapering intervention before elective primary hip or knee arthroplasty and its potential effectiveness compared with usual care.MethodsThis study was conducted at seven hospitals in New South Wales, Australia. Eligible patients were those aged ≥ 18 years, scheduled to undergo primary hip or knee arthroplasty for osteoarthritis and taking opioid analgesics pre‐operatively. The intervention group participated in an opioid tapering telehealth service, a partnership between a pharmacist and general practitioner, for 3 months pre‐operatively up to the day of surgery, while the control group received usual care. The primary outcomes of the study were to investigate the feasibility of the intervention (i.e. adherence to treatment) and potential effectiveness in decreasing baseline daily opioid dose by > 50% before surgery.ResultsBetween December 2021 and June 2023, 70 patients were recruited and assigned randomly to the intervention group (n = 35) or control group (n = 35). Baseline characteristics were similar between groups. Thirty patients in each group completed their allocated treatment. All patients allocated to the intervention group completed at least one appointment with a pharmacist, with the median (IQR [range]) being 2 (1–4 [1–6]) appointments. The number of patients who successfully decreased their baseline daily opioid dose by ≥ 50% before surgery was 27/30 in the intervention group compared with 5/30 in the usual care group (p < 0.001).ConclusionsThe findings of this pilot study support the feasibility of a telehealth‐delivered, pharmacist‐partnered opioid tapering service for patients scheduled for primary hip or knee arthroplasty. A broader multicentre study to examine the effectiveness of this intervention on clinical outcomes is warranted.

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Opioid stewardship

Cited by 3 publications

References 23 publications

Current advances in the pain treatment and mechanisms of Traditional Chinese Medicine

Current advances in the pain treatment and mechanisms of Traditional Chinese Medicine

Mitigating and preventing perioperative opioid-related harm

A pilot multicentre randomised clinical trial to determine the effect of a pharmacist‐partnered opioid tapering intervention before total hip or knee arthroplasty

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