Abstract
This international multidisciplinary consensus statement was developed to provide balanced guidance on the safe peri-operative use of opioids in adults. An international panel of healthcare professionals evaluated the literature relating to postoperative opioid-related harm, including persistent postoperative opioid use; opioid-induced ventilatory impairment; non-medical opioid use; opioid diversion and dependence; and driving under the influence of prescription opioids. Recommended strategies to reduce harm include pre-operative assessment of the risk of persistent postoperative opioid use; use of an assessment of patient function rather than unidimensional pain scores alone to guide adequacy of analgesia; avoidance of long-acting (modified-release and transdermal patches) opioid formulations and combination analgesics; limiting the number of tablets prescribed at discharge; providing deprescribing advice; avoidance of automatic prescription refills; safe disposal of unused medicines; reducing the risk of opioid diversion; and better education of healthcare professionals, patients and carers. This consensus statement provides a framework for better prescribing practices that could help reduce the risk of postoperative opioid-related harm in adults.
Highlights
Levy et al | Prevention of postoperative opioid-related harm than unidimensional pain scores alone to guide adequacy of analgesia; avoidance of long-acting opioid formulations and combination analgesics; limiting the number of tablets prescribed at discharge; providing deprescribing advice; avoidance of automatic prescription refills; safe disposal of unused medicines; reducing the risk of opioid diversion; and better education of healthcare professionals, patients and carers
As well as demonstrating that titration of opioids to unidimensional pain scores doubled the risk of opioid-induced ventilatory impairment, this study showed that reduced levels of consciousness were a more reliable marker of opioidinduced ventilatory impairment than reduced respiratory rates [85]
While the peri-operative use of opioids has the capacity to promote recovery after life-saving or life-enhancing surgery, their use can be associated with harm from persistent postoperative opioid use; opioid-induced ventilatory impairment; opioid diversion; and driving under the influence of prescription opioids
Summary
This international multidisciplinary consensus statement was developed to provide balanced guidance on the safe peri-operative use of opioids in adults. Than unidimensional pain scores alone to guide adequacy of analgesia; avoidance of long-acting (modifiedrelease and transdermal patches) opioid formulations and combination analgesics; limiting the number of tablets prescribed at discharge; providing deprescribing advice; avoidance of automatic prescription refills; safe disposal of unused medicines; reducing the risk of opioid diversion; and better education of healthcare professionals, patients and carers. Necessary to focus on opioid stewardship and the multiple components of the healthcare system needed to deliver these medicines safely, rather than relying solely on opioid-free techniques [4] This international multidisciplinary consensus statement was developed to provide balanced guidance on the safe peri-operative use of opioids, facilitating optimal functional recovery and reducing the risk of opioid-related harm in adult surgical patients. This guidance should assist healthcare professionals and hospitals across the world to implement effective opioid stewardship practices that achieve a balance between the administration of sufficient opioid analgesia to facilitate recovery and restoration of function, while concurrently minimising the risk of opioid-related harms
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