Opioid-free analgesia after surgery

Abstract

Acute pain is near universal after surgery. Opioids have been a mainstay of postoperative analgesia, but current best practice emphasises a multimodal opioid-sparing regimen based on a background of paracetamol, a non-steroidal anti-inflammatory drug, or both. 1 Neuman MD Bateman BT Wunsch H Inappropriate opioid prescription after surgery. Lancet. 2019; 393: 1547-1557 Summary Full Text Full Text PDF PubMed Scopus (162) Google Scholar Opioids are frequently overused, particularly after hospital discharge. 1 Neuman MD Bateman BT Wunsch H Inappropriate opioid prescription after surgery. Lancet. 2019; 393: 1547-1557 Summary Full Text Full Text PDF PubMed Scopus (162) Google Scholar , 2 Kaafarani HMA Han K El Moheb M et al. Opioids after surgery in the United States versus the rest of the world: the international patterns of opioid prescribing (iPOP) multicenter study. Ann Surg. 2020; 272: 879-886 Crossref PubMed Scopus (49) Google Scholar , 3 Bicket MC Long JJ Pronovost PJ Alexander GC Wu CL Prescription opioid analgesics commonly unused after surgery: a systematic review. JAMA Surg. 2017; 152: 1066-1071 Crossref PubMed Scopus (505) Google Scholar Opioid versus opioid-free analgesia after surgical discharge: a systematic review and meta-analysis of randomised trialsFindings from this meta-analysis support that opioid prescribing at surgical discharge does not reduce pain intensity but does increase adverse events. Evidence relied on trials focused on elective surgeries of minor and moderate extent, suggesting that clinicians can consider prescribing opioid-free analgesia in these surgical settings. Data were largely derived from low-quality trials, and none involved patients having major or major-complex procedures. Given these limitations, there is a great need to advance the quality and scope of research in this field. Full-Text PDF