Chronic Opioid Use After Surgery: Implications for Perioperative Management in the Face of the Opioid Epidemic

被引:549
作者
Hah, Jennifer M. [1 ]
Bateman, Brian T. [2 ]
Ratliff, John [3 ,4 ]
Curtin, Catherine [5 ]
Sun, Eric [6 ,7 ]
机构
[1] Stanford Univ, Dept Anesthesiol Perioperat & Pain Med, Div Pain Med, Stanford, CA 94305 USA
[2] Harvard Med Sch, Brigham & Womens Hosp, Dept Anesthesiol, Boston, MA USA
[3] Stanford Univ, Dept Neurosurg, Stanford, CA 94305 USA
[4] Stanford Univ, Dept Orthopaed Surg, Stanford, CA 94305 USA
[5] Stanford Univ, Div Hand & Plast Surg, Dept Orthopaed Surg, Stanford, CA 94305 USA
[6] Stanford Univ, Dept Anesthesiol Perioperat & Pain Med, Stanford, CA 94305 USA
[7] Stanford Univ, Dept Hlth Res & Policy, Stanford, CA 94305 USA
基金
美国国家卫生研究院;
关键词
TOTAL KNEE ARTHROPLASTY; NONSTEROIDAL ANTIINFLAMMATORY DRUGS; INDUCED RESPIRATORY DEPRESSION; PERSISTENT POSTSURGICAL PAIN; CONTROLLED-RELEASE OXYCODONE; CONFIRMATORY FACTOR-ANALYSIS; POSTOPERATIVE PAIN; RISK-FACTORS; UNITED-STATES; TOTAL HIP;
D O I
10.1213/ANE.0000000000002458
中图分类号
R614 [麻醉学];
学科分类号
100217 ;
摘要
Physicians, policymakers, and researchers are increasingly focused on finding ways to decrease opioid use and overdose in the United States both of which have sharply increased over the past decade. While many efforts are focused on the management of chronic pain, the use of opioids in surgical patients presents a particularly challenging problem requiring clinicians to balance 2 competing interests: managing acute pain in the immediate postoperative period and minimizing the risks of persistent opioid use after the surgery. Finding ways to minimize this risk is particularly salient in light of a growing literature suggesting that postsurgical patients are at increased risk for chronic opioid use. The perioperative care team, including surgeons and anesthesiologists, is poised to develop clinical-and systems-based interventions aimed at providing pain relief in the immediate postoperative period while also reducing the risks of opioid use longer term. In this paper, we discuss the consequences of chronic opioid use after surgery and present an analysis of the extent to which surgery has been associated with chronic opioid use. We follow with a discussion of the risk factors that are associated with chronic opioid use after surgery and proceed with an analysis of the extent to which opioid-sparing perioperative interventions (eg, nerve blockade) have been shown to reduce the risk of chronic opioid use after surgery. We then conclude with a discussion of future research directions.
引用
收藏
页码:1733 / 1740
页数:8
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