Reducing New Persistent Opioid Use After Surgery: A Review of Interventions

Abstract

Purpose of Review This review aims to summarize interventions used in the perioperative period to reduce the development of new persistent postoperative opioid use in opioid-naïve patients. Recent Findings The development of new persistent opioid use after surgery has recently been identified as a common postoperative complication. The existing literature suggests that interventions across the continuum of care have been shown to decrease the incidence of new persistent postoperative opioid use. Specific preoperative, intraoperative, and postoperative interventions will be reviewed, as well as the use of clinical pathways and protocols that span throughout the perioperative period. Common to many of these interventions include the use of multimodal analgesia throughout the perioperative period and an emphasis on a patient-centered, evidence-based approach to the perioperative pain management plan. Summary While the incidence of new persistent postoperative opioid use appears to be high, the literature suggests that there are both small- and large-scale interventions that can be used to reduce this. Technological advances including prescription monitoring systems and mobile applications have enabled studies to monitor opioid consumption after discharge. Interventions that occur preoperatively, such as patient education and expectation setting regarding postoperative pain management, and interventions that occur postoperatively, such as the implementation of procedure-specific, evidence-based prescribing guidelines and protocols, have been shown to reduce post-discharge opioid consumption. The use of multimodal analgesia and opioid-sparing adjuncts throughout the perioperative period is central to many of these interventions and has essentially become standard of care for management of perioperative pain.

Perioperative Pain Management With Opioid Analgesics in Colpopexy Increases Risk of New Persistent Opioid Usage

“…41 Given our finding that women who underwent laparoscopic repair were more likely to receive opioids within 7 days of the surgery than women who underwent vaginal reconstruction and that among those receiving perioperative opioids, rates of new persistent opioid usage did not differ by reconstructive surgical-approach, procedurespecific, evidence-based prescribing guidelines, including the creation of pain management order sets, may help reduce opioid use. 14 Patient-specific protocols, incorporating individual patient assessment, with follow-up assessments as needed for opioid prescribing with instructions to taper before discharge, may also help mitigate persistent postoperative opioid use and individual risk factors. 42 The limitations of this study are those inherent in research driven by a claims database, including patient deidentification, reliance on proper ICD-10 code classification, and lack of adherence and socioeconomic status data.…”

Institutional Opioid Prescription Guidelines are Effective in Reducing Post-Operative Prescriptions Following Urologic Surgery: Results From the American Urologic Association 2018 Census

“…ERPs have been shown to be safe and effective, though have been under-utilized across surgical subspecialities. [22][23][24] For example, a recent study of 113 Pediatric Urologists demonstrated that 61% were somewhat familiar or not familiar with standardized ERPs. While 54% utilized some individual ERP elements, only 20% had a complete standardized pathway.…”

Geriatric Considerations

“…While opioids have been the main therapy for acute pain management after major surgery, recent evidence documents that persistent opioid use after surgery represents a risk of opioid use disorder as a common postoperative complication. 21 Many of the current pain management pathways advocate for the use of multi-modal therapy to minimize the need for opioids and their side effects. 22 One study suggests that regional techniques targeting postoperative pain control in hip fracture patients may reduce the likelihood of postoperative delirium.…”