The Opioid Epidemic: Postoperative Pain Management Strategies in Orthopaedics.

Abstract

➢ Orthopaedic surgeons are currently estimated as the fourth highest opioid prescribers across all medical specialties. Preliminary research aimed at quantifying postoperative opioid utilization and prescribing patterns indicates that orthopaedic surgeons are inadvertently overprescribing opioids in the postoperative period.➢ Preoperative history gathering and communication are vital to a successful postoperative pain experience. Patient education on surgical intervention, prescription opioid misuse risk factors (smoking, preoperative prescription opioid use, and so forth), and maintenance of preoperative opioid naiveté can aid a patient in avoiding prescription opioid misuse.➢ Multimodal analgesia, in addition to a patient-centered prescription opioid regimen, is needed to address diverse pain pathways, to mitigate postoperative pain, and to minimize opioid utilization.➢ Use of prescription opioid universal precautions, standardized opioid taper regimens, tamper-resistant opioid formulations, and rapid cessation of opioid use in the postoperative period are strategies that can aid in monitoring and ensuring a successful and safe discontinuation of prescription opioid use following orthopaedic surgery.➢ Pain inherent in many orthopaedic surgical interventions, current limitations in effective analgesic treatment modalities, and growing awareness of the extensive adverse effects and nontherapeutic uses of opioids make strategies for postoperative pain control a highly complex problem that requires physicians to adopt patient and/or technique-specific approaches.