Ramani Moonesinghe: anaesthetist with a perioperative vision

Abstract

“I am a clinical academic who strives to improve perioperative care”, states the opening sentence of anaesthetist Professor Suneetha Ramani Moonesinghe's CV. And strive she does if the number of research groups and advisory bodies that she variously directs or belongs to is a relevant metric. “There are lots of people in academic medicine who are personally ambitious and driven”, says Viki Mitchell, one of Moonesinghe's fellow anaesthetists at London's University College Hospital (UCH) and its Divisional Clinical Director for Anaesthesia and Perioperative Medicine. “But Ramani has the skills to develop and encourage other people.” Sharon Drake, Deputy Chief Executive of the UK's Royal College of Anaesthetists, agrees. “She's one of those people who are able to manage a large and complex portfolio of work, but is also able to set the vision and bring people along with them.” Transition from acute to chronic pain after surgeryOver the past decade there has been an increasing reliance on strong opioids to treat acute and chronic pain, which has been associated with a rising epidemic of prescription opioid misuse, abuse, and overdose-related deaths. Deaths from prescription opioids have more than quadrupled in the USA since 1999, and this pattern is now occurring globally. Inappropriate opioid prescribing after surgery, particularly after discharge, is a major cause of this problem. Chronic postsurgical pain, occurring in approximately 10% of patients who have surgery, typically begins as acute postoperative pain that is difficult to control, but soon transitions into a persistent pain condition with neuropathic features that are unresponsive to opioids. Full-Text PDF Inappropriate opioid prescription after surgeryWorldwide, the use of prescription opioid analgesics more than doubled between 2001 and 2013, with several countries, including the USA, Canada, and Australia, experiencing epidemics of opioid misuse and abuse over this period. In this context, excessive prescribing of opioids for pain treatment after surgery has been recognised as an important concern for public health and a potential contributor to patterns of opioid misuse and related harm. In the second paper in this Series we review the evolution of prescription opioid use for pain treatment after surgery in the USA, Canada, and other countries. Full-Text PDF Perioperative opioid analgesia—when is enough too much? A review of opioid-induced tolerance and hyperalgesiaOpioids are a mainstay of acute pain management but can have many adverse effects, contributing to problematic long-term use. Opioid tolerance (increased dose needed for analgesia) and opioid-induced hyperalgesia (paradoxical increase in pain with opioid administration) can contribute to both poorly controlled pain and dose escalation. Hyperalgesia is particularly problematic as further opioid prescribing is largely futile. The mechanisms of opioid tolerance and hyperalgesia are complex, involving μ opioid receptor signalling pathways that offer opportunities for novel analgesic alternatives. Full-Text PDF