Jonathan S Jahr1, Sergio D Bergese2, Ketan R Sheth3,4, Nicholas M Bernthal5, Hung S Ho6, Nicoleta Stoicea2, Christian C Apfel7,8. 1. David Geffen School of Medicine, UCLA Medical Center, Los Angeles, California. 2. Departments of Anesthesiology and Neurological Surgery, The Ohio State University, Columbus, Ohio. 3. Division of General Surgery, Cambridge Health Alliance, Cambridge, Massachusetts. 4. Harvard Medical School, Boston, Massachusetts. 5. Department of Orthopedic Surgery, David Geffen School of Medicine at UCLA, Ronald Reagan UCLA Medical Center, Los Angeles, California. 6. Department of Surgery, UC Davis Medical Center, Davis, California. 7. Clinical Research Consultants, LLC, Larkspur, California. 8. University of California San Francisco School of Medicine, San Francisco, California, USA.
Abstract
Objective: Opioids represent an important analgesic option for physicians managing acute pain in surgical patients. Opioid management is not without its drawbacks, however, and current trends suggest that opioids might be overused in the United States. An expert panel was convened to conduct a clinical appraisal regarding the use of opioids in the perioperative setting. Methods: The clinical appraisal consisted of the review, presentation, and assessment of current published evidence as it relates to the statement "Opioids are not overused in the United States, even though opioid adjunct therapy achieves greater pain control with less risk." The authors' evaluation of this statement was also compared with the results of a national survey of surgeons and anesthesiologists in the United States. Results: We report the presented literature and proceedings of the panel discussion. The national survey revealed a wide range of opinions regarding opioid overuse in the United States. Current published evidence provides support for the efficacy of opioid therapy in surgical patients; however, it is not sufficient to conclude unequivocally that opioids are-or are not-overused in the management of acute surgical pain in the United States. Conclusions: Opioids remain a key component of multimodal perioperative analgesia, and strategic opioid use based on clinical considerations and patient-specific needs represents an opportunity to support improved postoperative outcomes and satisfaction. Future studies should focus on identifying optimal procedure-specific and patient-centered approaches to multimodal perioperative analgesia.
Objective: Opioids represent an important analgesic option for physicians managing acute pain in surgical patients. Opioid management is not without its drawbacks, however, and current trends suggest that opioids might be overused in the United States. An expert panel was convened to conduct a clinical appraisal regarding the use of opioids in the perioperative setting. Methods: The clinical appraisal consisted of the review, presentation, and assessment of current published evidence as it relates to the statement "Opioids are not overused in the United States, even though opioid adjunct therapy achieves greater pain control with less risk." The authors' evaluation of this statement was also compared with the results of a national survey of surgeons and anesthesiologists in the United States. Results: We report the presented literature and proceedings of the panel discussion. The national survey revealed a wide range of opinions regarding opioid overuse in the United States. Current published evidence provides support for the efficacy of opioid therapy in surgical patients; however, it is not sufficient to conclude unequivocally that opioids are-or are not-overused in the management of acute surgical pain in the United States. Conclusions: Opioids remain a key component of multimodal perioperative analgesia, and strategic opioid use based on clinical considerations and patient-specific needs represents an opportunity to support improved postoperative outcomes and satisfaction. Future studies should focus on identifying optimal procedure-specific and patient-centered approaches to multimodal perioperative analgesia.
Authors: Ketan R Sheth; Nicholas M Bernthal; Hung S Ho; Sergio D Bergese; Christian C Apfel; Nicoleta Stoicea; Jonathan S Jahr Journal: Medicine (Baltimore) Date: 2020-07-31 Impact factor: 1.817