Perioperative Opioid Use Research Articles

Impact of social determinants of health on perioperative opioid utilization in patients with lumbar degeneration

BackgroundSocial determinants of health (SDOH), have been demonstrated to significantly impact health outcomes in spine patients. There may be interaction between opioid use and these factors in spine surgical patients. We aimed to evaluate the social determinants of health (SDOH) which are associated with perioperative opioid use among lumbar spine patients. MethodsThis retrospective cohort study included patients undergoing spine surgery for lumbar degeneration in 2019. Opioid use was determined based on prescription records from the electronic medical records. Preoperative opioid users (OU) were compared with opioid-naïve patients regarding SDOH including demographics like age and race, and clinical data such as activity and tobacco use. Demographics and surgical data, including age, comorbidities, surgical invasiveness, and other variables were also collected from the records. Multivariate logistic regression was used for analysis of these factors. ResultsNinety-eight patients were opioid-naïve and 90 used opioids preoperatively. All OU had ≥3 months of use, had more prior spine surgeries (1.07 vs. 0.44, p<.001) and more comorbidities including diabetes, hypertension, and depression (p=.021, 0.043, 0.017). Patients from lower community median income areas, unemployed, or with lower physical capacity (METS<5) were more likely to use opioids preoperatively. Postoperative opioid use was strongly associated with preoperative opioid use, as well as alcohol use, and lower community median income. At one year postoperatively, OU had higher rates of opioid use [72.2% vs. 15.3%, p<.001]. ConclusionsUnemployment, low physical activity level, and lower community median income were associated with preoperative opioid use and longer-term opioid use postoperatively.

Comparative analysis of the effectiveness and safety of anesthetic care during neurosurgical interventions on the lumbar spine in patients with high-risk factors

The effectiveness and safety of providing anesthetic care during neurosurgical interventions on the spine in patients with high-risk factors are compared. The prospective comparative study included patients who had a high operational and anesthesiological risk according to the authors decision support system ( 8 points). All patients underwent open dorsal decompressive and stabilizing interventions from 2021 to 2023. Depending on the type of anesthesia and method of postoperative analgesia, three groups of patients were distinguished: in Group 1 (n = 41), intravenous anesthesia based on propofol and fentanyl was used; in Group 2 (n = 40), prolonged epidural analgesia with ropivacaine was additionally performed for 3 days after surgery; and in Group 3 (n = 43), multimodal analgesia was combined with preoperative intramuscular administration of ketoprofen and infiltration of the paraspinal muscles, subcutaneous fat, and skin with ropivacaine before access; intraoperative administration of dexmedetomidine; and postoperative administration of paracetamol. Comparative analysis included assessment of perioperative hemodynamic parameters, intensity of postoperative pain, perioperative use of opioids, dynamics of recovery of psychomotor functions, side effects of anesthesia, and postoperative surgical complications. It was found that the patients of Group 3, compared with the patients of Groups 1 and 2, had no significant changes in hemodynamics, obtained better results in the rate of recovery of psychomotor functions, and received a smaller intraoperative amount of opioid drugs. In Groups 2 and 3, a minimum level of postoperative local pain syndrome and a lower need for analgesics were recorded. The number of side effects of anesthesia in Group 1 was 29.3%; in Group 2, 27.5%; and in Group 3, 9.3% (p = 0.01). The number of postoperative surgical complications was comparable: Group 1, 7.3%; Group 2, 7.5%; and Group 3, 4.7% (p = 0.56). Thus, the use of complex perioperative anesthesia, in comparison with traditional anesthesia, including prolonged epidural analgesia, has advantages in the absence of depression of perioperative hemodynamic parameters and fewer side effects of anesthesia and postoperative surgical complications.

The association between perioperative opioids and breast cancer recurrence: a narrative review of the literature.

Opioid use disorder is an evolving crisis, and 17.2% of postsurgical patients continue to fill an opioid prescription one year after surgery. Preclinical studies suggest perioperative opioid use, defined here as opioids used in the setting of operative pain, may be linked to inferior oncologic outcomes. If this were true, opioid minimization strategies for surgical patients may reduce opioid-related deaths in more than one way. This review aims to describe the association between perioperative opioid use and breast cancer recurrence. On November 1, 2021, we searched the Ovid and EMBASE databases for the terms "breast neoplasm", "opioid analgesics", "neoplasm recurrence", and "neoplasm metastasis". Of the 350 articles retrieved, 11 met our inclusion criteria. The review was undertaken using the enhancing transparency in reporting the synthesis of qualitative research (ENTREQ) checklist for quality. Clinical studies report no clear association between perioperative opioid use and local or distant breast cancer recurrence. Mixed results were found when assessing perioperative opioid use and overall survival. Multiple studies paradoxically found opioid use to be associated with lower recurrence rates, despite higher mortality rates. Most studies showed no difference in recurrence or survival in breast cancer surgery patients who did or did not receive opioid-containing analgesia, although most findings were limited by study design and low event rates in patients with breast cancer. The lack of a clear connection between perioperative opioid use and breast cancer recurrence contradicts some preclinical data, which describes mechanisms through which opioids upregulate tumor proliferation which might worsen oncologic outcomes. Existing clinical literature is limited to mostly retrospective studies in patients with predominantly early-stage breast cancers, with low event rates. Given the worsening opioid epidemic and preclinical study findings, opioid minimization strategies should still be explored. Future work should be prospective and examine cancer recurrence in high-risk patients with more advanced tumor pathologies.

496 Erector Spine Plane Block Improves Analgesia After Minimally Invasive Awake Spine Surgery

INTRODUCTION: There is an emerging interest in lumbar spine surgery under spinal anesthesia (SA). Bilateral lumbar erector spinae plane (ESP) blocks are also described as a useful regional anesthetic technique to reduce post-operative pain after lumbar surgery. METHODS: A retrospective chart review was performed analyzing time in OR, first pain score in PACU after spinal wore off, pain scores throughout POD0, opioid requirements, PONV requiring rescue agent, and length of stay in patients that underwent spine surgery under SA before our practice adopted ESP blocks for back surgery versus patients that received an ESP block. For patients that received an ESP block, the injection was performed after skin closure above the level of the surgical intervention. Under ultrasound guidance, the erector spinae muscle layer was visualized and the block was performed with 15 ml of 0.5% bupivacaine mixed with 15 ml of liposomal bupivacaine (30 ml of local anesthetic per side). RESULTS: There was no significant difference in age, sex, ASA class, and BMI. Perioperative opioid use on POD0 was more than double in those not receiving a block (p = 0.0032). First pain score in recovery following conclusion of the spinal was greater than those who had received the intervention, p = 0.0209. Median length of stay in days was the same with a larger range in the non-intervention group. Incidence of nausea/vomiting was decreased in the group receiving ESP blocks. CONCLUSIONS: An ESP block can be used as an adjunct for minimally invasive spine surgery for enhancing recovery. Preliminary data suggests there is a trend for lower incidence of PONV as well as average pain scores on POD0 and a significant decrease in perioperative opioid use, increased same-day discharges, and improved pain scores upon conclusion of SA.

Pain Management After Cesarean Delivery Among Women with Opioid Use Disorder: Results from a Retrospective Pregnancy Cohort in a Rural Region of the Midwest.

Increasing numbers of pregnant women are being treated with buprenorphine for opioid use disorder (OUD), which can interfere with effectiveness of other opioids used for pain relief, making perioperative guidance for patients requiring cesarean delivery unclear. Using a retrospective cohort design, we abstracted 8 years of medical records (2013-2020) from a hospital in rural Michigan. We compared analgesic use (as a proxy for pain) and hospital length of stay (LOS) between groups of women with OUD whose buprenorphine treatment was (1) discontinued before cesarean delivery (discontinuation) versus (2) continued throughout the perioperative period (maintenance). We used t-tests and Fisher's Exact tests for comparison of continuous and categorical variables, respectively. Maternal characteristics reflected the local population (87% non-Hispanic White; 9% American Indian). Of 12,179 mothers giving birth during the study timeframe, 87 met all inclusion criteria (2.4% with diagnosed OUD; 38% of those delivered by cesarean; 76% of those received prenatal buprenorphine treatment). Using the first 2 days of the hospital stay as the standard time window for comparison, there were no differences in perioperative opioid analgesic use (mean ± standard deviation [SD] = 141.6 ± 205.4 vs. 134.0 ± 136.3 morphine milligram equivalents, p = 0.89) or LOS (mean ± SD = 2.9 ± 0.9 vs. 3.3 ± 1.0 days, p = 0.14) between discontinuation (n = 17) versus maintenance (n = 70). There was a lower use of acetaminophen in the discontinuation group (mean ± SD = 3,842.6 ± 2,108.1 vs. 4,938.2 ± 2,008.4 mg, p = 0.0489). This study provides empirical evidence supporting continued buprenorphine treatment for women with OUD throughout the perioperative period of a cesarean delivery in a rural setting, although replication with larger sample sizes would provide more confidence in the results.

The past, present, and future of opioid prescribing: Perioperative opioid use in gynecologic oncology patients after laparotomy at a single institution from 2012 to 2021

ObjectiveTo describe the evolution of perioperative opioid management in gynecologic oncology patients after open surgeries and determine current opioid over-prescription rates. MethodsPart one of this two-part study was a retrospective chart review of adult patients who underwent laparotomy by a gynecologic oncologist from July 1, 2012 to June 30, 2021, comparing changes in clinical characteristics, pain management and discharge opioid prescription sizes between fiscal year 2012 (FY2012) and 2020 (FY2020). In part two, we prospectively surveyed patients after laparotomy in 2021 to determine opioid use after hospital discharge. Results1187 patients were included in the chart review. Demographic and surgical characteristics remained stable from FY2012 to FY2020 with differences notable for increased rates of interval cytoreductive surgeries for advanced ovarian cancer and decreased rates of full lymph node dissection. Median inpatient opioid use decreased by 62 % from FY2012 to FY2020. Median discharge opioid prescription size was 675 oral morphine equivalents (OME) per patient in FY2012 and decreased by 77.7 % to 150 OME in FY2020. Of 95 surveyed patients in 2021, median self-reported opioid use after discharge was 22.5 OME. Patients had an excess of opioids equivalent to 1331 doses of 5-milligram oxycodone tablets per 100 patients. ConclusionInpatient opioid use in our gynecologic oncology open surgical patients and post-discharge opioid prescription size significantly decreased over the last decade. Despite this progress, our current prescribing patterns continue to significantly overestimate patients’ actual opioid use after hospital discharge. Individualized point of care tools are needed to determine an appropriate opioid prescription size.

POSTOPERATIVE PAIN AND MULTIMODAL ANESTHESIA IN ABDOMINAL PLASTIC AND BARIATRIC SURGERY

Any rational anesthesia strategy should focus on intraoperative and postoperative pain control. Adverse effects of opioids on the course of the early postoperative period are known. The aim of our study is to determine the correlations of acute postoperative pain with different types of anesthesia. Methods 203 patients who underwent abdominal plastic and bariatric surgery were under our observation; 113 (55.67%) of them are women and 90 (44.33%) are men; Among them, 154 patients underwent abdominoplasty, and 49 underwent bariatric surgery. Standard anesthesia with opioids was administered to 49 (24.14%) patients - group I, multimodal + partial use of opioids - group II: 76 (37.44%), multimodal anesthesia - 78 (38.42%) - group III. Results During anesthesia with opioids, compared to the second and third groups, the pain in the operative area, as well as in the head, throat, waist and ears is significantly higher. During multimodal anesthesia, pain is reliably less in all cases, and pain in the throat was not noted. Correlation analysis showed that opioid anesthesia was significantly correlated with postoperative pain,: Pain in the operated area - r=0.504**, p&lt;0.001; Head pain - r=0.395**, p&lt;0.001; Throat pain - r=0.301**, p&lt;0.001Waist painr=0.320**, &lt;0.001, Muscles pain - r=0.422**, p&lt;0.001 whereas multimodal anesthesia was significantly negatively correlated with all types of postoperative pain. In the second phase, in the opioid anesthesia group, compared to the second group, there is significantly more pain in the lower back and muscles, and in the third group, there was no pain at all. The frequency of patients who did not require medical treatment during the intrahospital stage is not significantly different from each other, and the pain requiring non-opioid treatment is significantly less after multimodal anesthesia - Group I - 28(57.14%), Group II - 25(32.89%), Group III - 2(2.56)(p&lt;0.0001). Pain requires opioid medication - Group I - 20(40.82)Group II – 19(25.00%), (p&lt;0.0001). No patient in this group required opioid treatment. In the ambulatory stage, no patient in the multimodal anesthesia group needed medical treatment, and significantly fewer patients in group II needed non-opioid treatment. Conclusion Multimodal anesthesia reduces perioperative pain and the need for perioperative opioid use. Keywords: Postoperative pain, Multimodal anesthesia, perioperative opioid use.

Regional anesthesia improves inpatient but not outpatient opioid demand in tibial shaft fracture surgery.

Patients undergoing operative treatment of tibial shaft fractures have considerable pain largely managed with opioids. Regional anesthesia (RA) has been increasingly used to reduce perioperative opioid use. This was a retrospective study of 426 patients that underwent operative treatment of tibial shaft fractures with and without RA. Inpatient opioid consumption and 90-day outpatient opioid demand were measured. RA significantly decreased inpatient opioid consumption for 48h post-operatively (p = 0.008). Neither inpatient use after 48h nor outpatient opioid demand differed in patients with RA (p > 0.05). RA may help with inpatient pain control and reduce opioid use in tibial shaft fracture. Level III, retrospective, therapeutic cohort study.

Safety implications of concomitant administration of antidepressants and opioid analgesics in surgical patients

ABSTRACT Background Commonly prescribed antidepressants (paroxetine, fluoxetine, duloxetine, bupropion) inhibit bioconversion of several prodrug opioid medications to their active metabolite, potentially decreasing analgesic effect. There is a paucity of studies assessing the risk-benefit of concomitant administration of antidepressants and opioids. Research design and methods Observational study of adult patients taking antidepressants prior to scheduled surgery using 2017–2019 electronic medical record data to assess perioperative use of opioids and to determine the incidence and risk factors for developing postoperative delirium. We conducted a generalized linear regression with the Gamma log-link to assess the association between use of antidepressants and opioids and a logistic regression to assess the association between antidepressants use and the likelihood of developing postoperative delirium. Results After controlling for patient demographic and clinical characteristics, and postoperative pain, use of inhibiting antidepressants was associated with 1.67 times greater use of opioids per hospitalization day (p = 0.00154), a two-fold increase in the risk for developing postoperative delirium (p = 0.0224), and an estimated average of four additional days of hospitalization (p < 0.00001) compared to use of non-inhibiting antidepressants. Conclusions Careful consideration to drug-drug interactions and risk of related adverse events remains critical in the safe and optimal management of postoperative pain in patients taking concomitantly antidepressants.

Impact of Perioperative Ketamine on Postoperative Bariatric Surgery Opioid Use and Length of Stay.

Postoperative pain management is an ever-growing challenge with the rise of the opioid crisis. Ketamine is an NMDA channel blocker, considered an alternative to perioperative opioid use; small concentrations are safe. Objective: The primary objective of this study was to evaluate the impact of perioperative ketamine administration on postoperative opioid use and the length of hospital stay in bariatric patients. Four hundred (366) charts were retrospectively reviewed; of those, 187 received ketamine and were placed in the Ketamine group, 179 received standard-of-care pain management and were part of the No-Ketamine group. Data was collected using medical databases from July 2020 to January 2021. A greater length of stay was recorded in the No-Ketamine group (45.67±20.6 hours) when compared with the Ketamine group (40.6±14.3 hours); P<0.05. The Ketamine group had a mean MME of 17.5±16.5 whereas the No-Ketamine had a mean MME of 22.3±17.7, P<0.05. Ketamine may be a feasible alternative to reduce opioid use and hospital length of stay. We believe that ketamine can be an important contribution to ERABS pathways, being responsible for improved outcomes after bariatric/metabolic surgical procedures.

Effects of different anesthesia methods on postoperative immune function in patients undergoing gastrointestinal tumor resection

To investigate the effects of different anesthetic methods on postoperative immune function in patients undergoing gastrointestinal tumor resection. Ninety patients undergoing laparoscopic gastrointestinal tumor resection were divided into 3 groups. Patients in the GA group were anesthetized by total intravenous anesthesia. The GE group was anesthetized by general anesthesia combined with epidural anesthesia. The GN group was anesthetized by general anesthesia combined with bilateral Transversus Abdominis Plane block (TAP) and rectus sheath nerve blocks. General anesthesia is total intravenous anesthesia in all three groups. Blood samples were taken to test the changes of peripheral lymphocyte subtype analysis, and levels of plasma cortisol, epinephrine, norepinephrine. Also, the dosage of anesthetic drugs, recovery time, and visual analog scale (VAS) scores were recorded. Postoperative immune indexes, including CD4 count, CD8 count, B, and NK cells, in the GE group were significantly higher than those in NA and GA groups (P < 0.01). Perioperative stress indices, including epinephrine levels, norepinephrine level and aldosterone level, in the GE group were significantly lower than in the GA group and GN group (P < 0.01). The intraoperative/total sufentanil dosage and remifentanil dosage in the GE group were significantly lower than those in the GA and GN groups (P < 0.01). The VAS scores in the GE group were significantly better than those in GA and GN groups (P < 0.01). General anesthesia combined with epidural anesthesia attenuates the increase in inflammatory mediators. Its possible mechanisms include reducing perioperative stress response and reducing perioperative opioid use.

Effect of continuous post-operative lidocaine infusion in an enhanced recovery program on opioid use following gynecologic oncology surgery.

To determine the effectiveness of implementing an Enhanced Recovery After Surgery (ERAS) program, including continuous intraoperative and postoperative intravenous (IV) lidocaine infusion, on perioperative opioid use. This was a single-institution retrospective pre- post- cohort study. Consecutive patients undergoing planned laparotomy for known or potential gynecologic malignancy were identified after implementation of an ERAS program and compared to a historical cohort. Opioid use was calculated as morphine milligram equivalents (MMEs). Cohorts were compared using bivariate tests. A total of 215 patients were included in the final analysis, 101 patients received surgery before ERAS implementation and 114 received surgery after. A reduction in total opioid use was observed in ERAS patients compared with historical controls (MME 26.5 [9.6-60.8] versus 194.5 [123.8-266.8], p<0.001). Length of stay (LOS) was reduced by 25% in the ERAS cohort (median 3 days, range 2-26, versus 4 days, range 2-18; p<0.001). Within the ERAS cohort, 64.9% received IV lidocaine for the planned 48 hours, and 5.6% had the infusion discontinued early. Within the ERAS cohort, patients who received IV lidocaine infusion used less opioids compared to those who did not (median 16.9, range 5.6-55.1, versus 46.2, range 23.2-76.1; p<0.002). An ERAS program including a continuous IV lidocaine infusion as the opioid-sparing analgesic strategy was noted to be safe and effective, leading to decreased opioid consumption and LOS compared with a historic cohort. Additionally, lidocaine infusion was noted to decrease opioid consumption even among patients already receiving other ERAS interventions.

Surgeon-Delivered Nerve Block for Reduction of Perioperative Pain and Opioid Use After Lumbosacral Spine Surgery.

This cohort study compares postoperative pain scores, opioid use, and length of hospital stay among adults undergoing noninstrumented lumbosacral surgery who received x-ray–guided dorsal ramus block vs those who did not.

Pain Control and Satisfaction With Peripheral Nerve Blocks for Upper Extremity Surgery.

Regional anesthesia ("block") is an important component of upper extremity (UE) surgery pain control. However, little is known about patient experience related to perioperative opioid use. This study assessed patient-reported pain control and satisfaction with UE blocks and evaluated how opioid consumption impacted these outcomes before the block "wore off." A postoperative phone survey was administered to patients who underwent outpatient UE surgery at a surgery center for more than 16 months. It assessed pain scores (scale 1-10), satisfaction with block duration (scale 1-5), duration until return of UE function, and opioid consumption. Analyses used Mann-Whitney U tests, Fisher exact tests, and bivariate and multivariable linear and ordered logistic regressions to understand relationships between opioid use and outcomes. A total of 509 patients (61%) completed the survey, and 441 (88%) were satisfied with block duration. Initial and final pain scores were significantly higher in patients who took opioids prior to the block wearing off (6 and 4.5, P = .04 and 3.5 and 2, P = .002, respectively). Although satisfaction with block duration was not different in group comparisons (ie, patients who premedicated vs those who did not), in a multivariable analysis, patients who premedicated with opioids had 78% increased odds of reporting the highest level of satisfaction compared with the lower 4 levels (P = .03). Upper extremity blocks are associated with high overall patient satisfaction and postsurgical pain control. Premedicating before the block wears off may increase patient satisfaction with block duration even if pain is not notably impacted.

The Burden of Postoperative Delirium After Shoulder Arthroplasty and Modifiable Pharmacological Perioperative Risk Factors: A Retrospective Nationwide Cohort Study.

Background: Increasing demand for shoulder arthroplasty and an aging population may increase the rate of complications associated with advanced age such as postoperative delirium, but little is known on its burden in this cohort. Purpose: We sought to answer the following questions: (1) What is the epidemiology of postoperative delirium after shoulder arthroplasty? (2) What modifiable risk factors can be identified for postoperative delirium after shoulder arthroplasty? (3) Do risk factors differ in those younger than and in those older than 70 years of age? Methods: In a retrospective nationwide cohort study, we extracted data from the Premier Healthcare database on inpatient total and reverse shoulder arthroplasties from 2006 to 2016. The primary outcome was postoperative delirium; modifiable risk factors of interest were perioperative opioid use (high, medium, or low), peripheral nerve block use, and perioperative prescription medications. Mixed-effects models assessed associations between risk factors and postoperative delirium. Odds ratios and confidence intervals are reported. We applied a cutoff of 70 years of age because it was the median age of the cohort, as well as the age at which we observed that delirium prevalence increased. Results: A total of 92,429 total and reverse shoulder arthroplasties were identified (age range: 14-89 years). Overall delirium prevalence was 3.1% (n = 2909). Age-specific prevalence of postoperative delirium was lower in patients aged 50 to 70 years and higher in those aged 70 years and older, up to 8% among those older than 88 years. After adjusting for relevant covariates, only long-acting and combined short-acting and long-acting benzodiazepines (compared with no benzodiazepines) were associated with increased odds of postoperative delirium. Corticosteroids were associated with decreased odds of postoperative delirium. Conclusion: Our retrospective cohort study demonstrated that benzodiazepine use and older patient age were significantly associated with postoperative delirium in shoulder arthroplasty patients. The relationship between benzodiazepine use and delirium was particularly notable among those 70 years of age and older. Further investigation is indicated, given the known adverse effects of benzodiazepines in older adults and our findings of higher than expected use of these medications in this surgical cohort.

Perioperative NSAID use in single level microdiscectomy and hemilaminectomy

The opioid crisis is a global issue and reduction of perioperative opioid use is paramount to help resolve the crisis. In this study. we investigated the prescribing habits of doctors in a single institution following a single level microdiscectomy or hemilaminectomy and the effect on discharge opioid medications and if the concurrent use of NSAIDs affected opioid use in this patient population. Between Jan 2016 and June 2021, 238 patients underwent either a microdiscectomy or hemilaminectomy. 131 patients received NSAIDs in the perioperative period and 107 did not. Use of NSAIDs was found to be associated with a shorter length of stay (2.6 vs 3.0 days, p = 0.014). Use of NSAIDs was associated with reduced opioid use at outpatient review, however, this was not statistically significant. NSAID use in this population did not result in any clinically significant adverse effects.In patients undergoing single level microdiscectomy and hemilaminectomy, use of NSAIDs is safe and associated with a reduced length of stay. Further qualitative randomised controlled trials are required to validate the efficacy of opioid reduction with NSAID use in patients undergoing single level microdiscectomies and hemilaminectomies.

Continuing Chronic Buprenorphine Perioperatively is Associated With Reduced Postoperative Opioid Use

IntroductionBuprenorphine is a frequently used medication for opioid use disorder and misunderstanding buprenorphine's unique pharmacology has historically complicated perioperative analgesia. The purpose of this study was to evaluate the association of perioperative buprenorphine continuation in patients with substance use disorder on perioperative opioid use. Materials and methodsThis was a single-center retrospective study at a level 1 trauma academic medical center. Adult patients using outpatient buprenorphine for medication for opioid use disorder admitted with an operating room booking were included. Patients were grouped (continuation, withheld) retrospectively based upon the decision to continue or omit buprenorphine therapy while admitted. The primary outcome of the study was any use of full mu-opioid agonists during days 1-7 of admission. Secondary outcomes included length of stay and average pain scores during days 1-7 of admission. Results43.4% of patients in the continuation cohort used no full mu-opioid agonists during days 1-7 compared to 3.1% of patients in the withheld cohort (P < 0.001). No significant difference in median length of stay was noted (4.7 d [2.8-6.6] versus 6.1 d [4.0-8.2], P = 0.36). There was no statistical difference in average pain scores on postoperative days 1 (5.2 versus 6.9, P = 0.82) and 7 (0 versus 0, P = 0.41). ConclusionsPerioperative continuation of buprenorphine is associated with reduced use of alternative full mu-opioid agents while admitted without impacting pain scores.

Enhanced recovery after cardiac surgery protocol reduces perioperative opioid use

ObjectiveEnhanced Recovery After Surgery protocols are relatively new in cardiac surgery. Enhanced Recovery After Surgery addresses perioperative analgesia by implementing multimodal pain control regimens that include both opioid and nonopioid components. We investigated the effects of an Enhanced Recovery After Surgery protocol at our institution on postoperative outcomes with particular focus on analgesia. MethodsSingle-center retrospective study comparing perioperative opioid use before and after implementation of an Enhanced Recovery After Surgery protocol at our institution. Subjects were divided into 2 cohorts: Enhanced Recovery After Surgery (study group from year 2020) and pre–Enhanced Recovery After Surgery (control group from year 2018). Baseline and perioperative variables including total opioid use from the day of surgery to postoperative day 5 were collected. Opioid use was calculated as morphine milligram equivalents and compared between the 2 cohorts. ResultsA total of 466 patients were included: 250 in the Enhanced Recovery After Surgery group and 216 in the pre–Enhanced Recovery After Surgery group. Both groups had similar baseline characteristics, but the Enhanced Recovery After Surgery group had significantly more subjects with intravenous drug use history (P < .0001), endocarditis (P < .0001), and liver disease (P = .007) compared with the pre–Enhanced Recovery After Surgery group. Every day from the day of surgery to postoperative day 5, the Enhanced Recovery After Surgery group had significant reduction (57%) in opioid use compared with the pre–Enhanced Recovery After Surgery group. Total opioid use for the entire length of stay was 259 morphine milligram equivalents in the Enhanced Recovery After Surgery group versus 452 morphine milligram equivalents in the pre–Enhanced Recovery After Surgery group (P < .0001). Subgroup analysis of subjects with intravenous drug use history did not demonstrate a significant reduction in opioid use. ConclusionsEnhanced Recovery After Surgery protocols with an emphasis on multimodal pain management throughout perioperative care are associated with a significant reduction in the postoperative use of opioid analgesics.

Prospective cohort study on the trajectory and association of perioperative anxiety and postoperative opioid-related outcomes

IntroductionAlthough perioperative anxiety is common, its trajectory and influence on postoperative pain and opioid use are not well understood. We sought to examine the association and trajectory of perioperative anxiety,...

Hospital admission medication reconciliation in high-risk prescription opioid users

No studies have assessed the clinical significance of medication reconciliation in surgical patients using high-risk extended-release/long-acting (ER/LA) opioid medications.We assessed differences in the perioperative use of opioid analgesics in patients who underwent medication reconciliation upon hospital admission compared to patients who did not and identified predictors of perioperative use of opioids.Retrospective observational quasi-experimental study including adult non-cancer patients who underwent elective surgery at UCSF Medical Center in the period January 2017 through December 2019 and received at least one opioid analgesic during surgical hospitalization. The primary study outcome was perioperative use of opioids measured in daily oral morphine equivalents (OME). Secondary outcomes were predictors of perioperative use of opioids after adjusting for baseline differences between groups.We identified 402 patients. Of them, 59.5% were female. The mean patient age was 58.5 years. Most patients underwent neurological or orthopedic surgery (each 40.8%). Over 94.3% of our patients underwent medication reconciliation upon hospital admission, with 78.4% completed by a pharmacy staff. Medication reconciliation evidenced that 5.5% patients were not taking the ER/LA opioids on their medication history list. Inactive ER/LA opioids were discontinued during hospitalization. None of the patients with inactive ER/LA opioids had those opioids restarted at hospital discharge. In addition, patients (26.9%) were successfully converted from ER/LA to SA opioids. After adjusting for patients' demographic and clinical characteristics, surgical procedure type and post-operative pain, opioid formulation conversion was the main predictor of perioperative use of opioids per hospitalization day. Switching patients from ER/LA to SA opioids reduced the mean daily use of OME by 66.03 units (p < 0.02) without adversely impacting postoperative pain.Medication reconciliation upon hospital admission reduced unnecessary exposure to opioids in hospitalized surgical patients.