Optimizing Perioperative Use of Opioids: a Multimodal Approach
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OPIOID USE IN AN OPIOID EPIDEMIC (S DALAL, SECTION EDITOR)
Optimizing Perioperative Use of Opioids: a Multimodal Approach Maria F. Ramirez 1,2 & Brinda B. Kamdar 3 & Juan P. Cata 1,2
# Springer Science+Business Media, LLC, part of Springer Nature 2020
Abstract Purpose of Review The main purpose of this article is to review recent literature regarding multimodal analgesia medications, citing their recommended doses, efficacy, and side effects. The second part of this report will provide a description of drugs in different stages of development which have novel mechanisms with less side effects such as tolerance and addiction. Recent Findings Multimodal analgesia is a technique that facilitates perioperative pain management by employing two or more systemic analgesics along with regional anesthesia, when possible. Even though opioids and non-opioid analgesics remain the most common medication used for acute pain management after surgery, they have many undesirable side effects including the potential for misuse. Newer analgesics including peripheral acting opioids, nitric oxide inhibitors, calcitonin gene–related peptide receptor antagonists, interleukin-6 receptor antagonists, and gene therapy are under intensive investigation. Summary A patient’s first exposure to opioids is often in the perioperative setting, a vulnerable time when multimodal therapy can play a large role in decreasing opioid exposure. Additionally, the current shift towards faster recovery times, fewer postoperative complications, and improved cost-effectiveness during the perioperative period has made multimodal analgesia a central pillar of Enhanced Recovery After Surgery (ERAS) protocols. Keywords Analgesic . Opioids . Multimodal analgesia . Surgery
Introduction Poorly controlled postoperative pain is associated with patient dissatisfaction, impaired respiratory function, immunosuppression, prolonged ileus, delayed recovery times, inability to participate in rehabilitation, and higher healthcare costs [1, 2]. More importantly, inadequate pain control can lead to development of chronic postsurgical pain and persistent Maria F. Ramirez and Brinda B. Kamdar contributed equally to this work. MFR and BBK are co-first authors This article is part of the Topical Collection on Opioid Use in an Opioid Epidemic * Juan P. Cata [email protected] 1
Department of Anesthesiology and Perioperative Medicine, The University of Texas MD Anderson Cancer Center, Unit 409, 1515 Holcombe Blvd., Houston, TX 77005, USA
2
Anesthesiology and Surgical Oncology Research Group, Houston, TX, USA
3
Department of Anesthesia, Critical Care, and Pain Medicine, Massachusetts General Hospital, Boston, MA, USA
opioid use and abuse [3]. In light of the opioid epidemic, the reduction of opioid use perioperatively has become a priority for practitioners prescribing these drugs. When developing strategies to reduce opioid exposure in a rational manner, essential considerations include the ease of administration, drug toxicity, long-lasting effects, and the non-addictive p
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