Pain or No Pain, We Will Give You Opioids: Relationship Between Number of Opioid Pills Prescribed and Severity of Pain after Operation in US vs Non-US Patients

Perioperative Pain Management and Opioid Stewardship: A Practical Guide

“…3 Oral equianalgesic dose equivalent of 30 mg has been used and is also reasonable, given variations in bioavailability between morphine/hydrocodone and oxycodone (equianalgesic ratio ranges from 1:1 to 2:1 morphine:oxycodone based on individual patient absorption). 4 Previous resources have used a 1:5 ratio for parenteral:oral hydromorphone, but newer data suggest a ratio 1:2.5 is more appropriate. IM = intramuscular, IV = intravenous, mg = milligrams, N/A = not applicable, PO = oral, SC = subcutaneous, SL = sublingual.…”

“…3 Available concentrations of hydromorphone injectable should determine the measurable dose, within this range, in order to ensure practical drug administration (e.g., rounded doses to the nearest 0.1 mL or 0.25 mL). 4 A number of practical strategies exist to accomplish this-see Section 3.5.3). Abbreviations: IV = intravenous, IVP = intravenous push, PO = oral or by mouth, SC = subcutaneous, SL = sublingual.…”

“…Until recently, evidence-based guidelines on postoperative opioid prescribing were not readily available. Variable and often excessive opioid quantities have been prescribed after surgery, especially in the U.S. [4,473]. In 2016, the Michigan Opioid Prescribing Engagement Network (OPEN) released procedure-specific guidelines to help reduce overprescribing of opioids after surgery.…”

“…Suboptimal postoperative pain management is associated with worsened humanistic and economic outcomes, including the development of chronic pain and opioid dependence [2]. In the U.S., opioid analgesics have been the cornerstone of postoperative pain management, driven by earlier efforts to improve treatment of pain and societal expectations for surgical recovery [3][4][5]. The significant risks and costs associated with opioid overuse are now better understood: opioid-related adverse events frequently potentiate complications in postoperative populations and postsurgical opioid prescribing patterns have contributed to the modern U.S. opioid epidemic [6][7][8][9][10][11].…”

“…The significant risks and costs associated with opioid overuse are now better understood: opioid-related adverse events frequently potentiate complications in postoperative populations and postsurgical opioid prescribing patterns have contributed to the modern U.S. opioid epidemic [6][7][8][9][10][11]. Postoperative opioid prescribing in the U.S. remains alarmingly high and in stark contrast to that of non-U.S. countries, underscoring the need for more widespread adoption of multimodal analgesia and enhanced recovery strategies by American centers [4,[12][13][14].…”