Perioperative Opioids, the Opioid Crisis, and the Anesthesiologist

Q: What is the clinical evidence from this study?

Study design: Review. Population: Perioperative pain and opioid use. Intervention: Personalized perioperative anesthesia and opioid management strategies.

Daniel B. Larach; Jennifer M. Hah; Chad M. Brummett

doi:10.1097/aln.0000000000004109

February 2, 2022AnesthesiologyOpen Access

Perioperative Opioids, the Opioid Crisis, and the Anesthesiologist

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Key result

Tailored perioperative strategies reduce excess postoperative opioid use without compromising analgesia across surgical settings.

Key Points

To summarize current evidence regarding perioperative opioid prescribing and consumption, while outlining personalized anesthesia strategies to reduce opioid-related harms without sacrificing analgesia.
Narrative review synthesizing clinical evidence and epidemiological data on perioperative opioid fulfillment, persistent postoperative opioid use, and surgical prescribing trends.
Evaluation of risk factors, definitions of persistent opioid use, and clinical interventions spanning preoperative assessment through post-discharge pain management.
New persistent postoperative opioid use among previously opioid-naïve patients ranges from 0.01% to 14.7% across surgical cohorts, including 7.7% after minor surgery in older adults and 4.8% following common pediatric procedures.
Preoperative opioid use substantially elevates post-surgical risks, with 64% to 77% of chronic pre-surgical users continuing to fill opioid prescriptions postoperatively and displaying an adjusted 2.4-fold higher odds of persistent use if taken for other pain complaints.
Postoperative opioid overprescribing remains common, with patients consuming only 29% to 58% of prescribed opioid tablets, creating surplus medication vulnerable to diversion and misuse.

Structured PICO

P

Population

Surgical patients receiving perioperative anesthesia and analgesic care, including opioid-naive patients, chronic opioid users, and patients with opioid use disorder.

I

Intervention

Personalized perioperative opioid management strategies, including preoperative risk identification, patient expectation setting, transitional pain services, preoperative opioid weaning, multimodal/regional analgesia, behavioral/educational interventions, continuation of opioid use disorder medications (buprenorphine, methadone), and surgery-specific discharge prescribing guidelines.

O

Outcome

Persistent postoperative opioid use, opioid misuse, post-discharge opioid prescribing and consumption, and postoperative pain control.

This narrative review outlines practical perioperative strategies for anesthesiologists—from preoperative risk stratification and expectation setting to tailored post-discharge prescribing—to mitigate persistent postoperative opioid use and misuse without compromising acute pain control.

Limitations

Significant data heterogeneity exists regarding the incidence and definition of new persistent postoperative opioid use
Reliance on administrative claims and electronic health record data prevents distinguishing between opioid prescribing and actual consumption
Lack of high-quality evidence regarding pharmacotherapy for preventing acute-to-chronic pain transition and the efficacy of transitional pain clinics
Overall level of evidence related to opioid-free anesthesia is low
Rigorous research to inform evidence-based acute pain management in patients receiving opioid use disorder treatment is lacking
Significant data heterogeneity regarding definitions and incidence of new persistent postoperative opioid use
Administrative claims and EHR data cannot distinguish between opioid prescribing/fulfillment and actual patient consumption
Lack of high-quality data on the efficacy and cost-effectiveness of transitional pain clinics
Low overall level of evidence related to intraoperative opioid-free anesthesia
Lack of rigorous research for perioperative acute pain management in patients on opioid use disorder maintenance therapy, relying mostly on expert opinion and case reports

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Implication

Supports individualized perioperative opioid stewardship; leaves open need for prospective trials to confirm efficacy.

Abstract

In Brief This review summarizes current evidence related to perioperative opioid prescription fulfillment and use and discusses the role of personalized anesthesia care in mitigating opioid-related harms without compromising analgesia.

Discussion

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Cite This Study

Larach et al. (2022) conducted a review in Perioperative pain and opioid use. Personalized perioperative anesthesia and opioid management strategies was evaluated. Personalized perioperative care, expectation setting, and surgery-specific prescribing guidelines can reduce excess postoperative opioid use without compromising analgesia, though new persistent use ranges from 0.01% to 14.7%.

synapsesocial.com/papers/6a74c1b99c92392688b1daf5 https://doi.org/10.1097/aln.0000000000004109

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Perioperative Opioids, the Opioid Crisis, and the Anesthesiologist

Key Points

Structured PICO

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

Perioperative Opioids, the Opioid Crisis, and the Anesthesiologist

Key Points

Structured PICO

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

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