Managing Prolonged Pain After Surgery: Examining the Role of Opioids

J Arthroplasty. 2018 Nov;33(11):3389-3393. doi: 10.1016/j.arth.2018.08.005. Epub 2018 Aug 13.

Abstract

A notable minority of patients experience persistent postsurgical pain and some of these patients consequently have prolonged exposure to opioids. Risk factors for prolonged opioid use after surgery include preoperative opioid use, anxiety, substance abuse, and alcohol abuse. The window to intervene and potentially prevent persistent opioid use after surgery is short and may best be accomplished by both surgeon and anesthesiologist working together. Anesthesiologists in particular are well positioned in the perioperative surgical home model to affect multiple aspects of the perioperative experience, including tailoring intraoperative medications and providing consultation for possible discharge analgesic regimens that can help minimize opioid use. Multimodal analgesia protocols reduce opioid consumption and thereby reduce exposure to opioids and theoretically the risk of persistent use. Regional anesthesia and analgesia techniques also reduce opioid consumption. Although many patients will recover without difficulty, the small minority who do not should receive customized care which may involve multiple office visits or consultation of a pain specialist. Enhanced recovery pathways are useful in optimizing outcomes after surgery.

Keywords: multimodal analgesia; opioid epidemic; persistent opioid use after surgery; persistent postsurgical pain; total joint arthroplasty.

Publication types

  • Review

MeSH terms

  • Analgesia / methods
  • Analgesics / therapeutic use
  • Analgesics, Opioid / administration & dosage*
  • Anesthesia, Conduction
  • Arthroplasty, Replacement, Knee / adverse effects
  • Drug Prescriptions
  • Humans
  • Opioid-Related Disorders / etiology
  • Pain Management / methods
  • Pain, Postoperative / drug therapy*
  • Pain, Postoperative / etiology

Substances

  • Analgesics
  • Analgesics, Opioid