Perioperative Management of Patients with Addiction to Opioid and Non-opioid Medications

Abstract

Statistics from the CDC demonstrate a shocking increase in opioid prescription rates and opioid-related deaths. Furthermore, opioid-addicted patients have notoriously undertreated pain in the perioperative period. A multitude of strategies are available in the perioperative period to treat pain in these patients. Formulating treatment plans for opioid and non-opioid-addicted patients undergoing surgery should include considerations in the pre-, intra-, and post-operative period. Our review article outlines several non-opioid modalities which may be employed to treat pain in these patients; however, particularly in the opioid-addicted population, the practitioner must be aware that non-opioids alone may not suffice to treat post-surgical pain. Consultation with pain management may be warranted to optimize opioid and non-opioid treatment for these patients.

Substance Use Disorders: Basic Overview for the Anesthesiologist

“…Available data highly recommend the use of regional anesthesia and multimodal analgesia approaches in patients with known SUDs. 54,89,90 Additionally, anesthesiologists www.anesthesia-analgesia.org aNeStHeSia & aNalGeSia Substance Use Disorder and Anesthesia must remain vigilant for patient harm immediately after surgery. For example, patients with OUD often require higher doses of opioids to treat postoperative pain.…”

“…COVID and SUDs of social distancing and pandemic-related financial hardship: anxiety, depression, posttraumatic stress disorder Worsening SUDs (progression from mild to severe SUDs) Barriers to health care/SUDs treatment leading to higher rate of recurrence Overdose related deaths Potential relationships between COVID-19 and SUD are described 9,10,[88][89][90]. Abbreviations: COVID-19, coronavirus disease 2019; SARS-CoV-2, severe acute respiratory syndrome coronavirus 2; SUD, substance use disorder.…”

Managing Pain in the Setting of Opioid Use Disorder

“…Table 2 presents a summary of MOUD. Multimodal analgesia utilizing medications and regional analgesia techniques (when appropriate) should always be part of the pain management plan for all individuals (Harrison, Kornfeld, Aggarwal, & Lembke, 2018;Kumar, Kirksey, Duong, & Wu, 2017;Thomas, Boominathan, Goswami, Mukherjee, & Vadivelu, 2018) and is especially important for OUD patients for whom the risks of opioid use may outweigh the benefits. Nonpharmacological approaches can be used to help patients manage pain in the context of OUD.…”

Written Prescription for Over-the-Counter Nonopioid Pain Medications Does Not Increase the Likelihood of Use after Ambulatory Hand and Upper Extremity Surgery

“…1 2 This epidemic has been perpetuated by aggressive prescribing practices and rising rates of prescription and illicit opioid overdose-related deaths. 3 4 5 In many developed countries, there has been a rapid increase in the number of patients prescribed opioids, further increasing the potential for diversion and abuse. 6 There is also evidence that patient ethnicity can have an impact on the amount of narcotic medication prescribed postoperatively.…”