We Asked the Experts: Reducing Opioid Prescription After Abdominal Surgery; A Place for Nerve Block and Wound Infiltrati
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EDITORIAL PERSPECTIVE
We Asked the Experts: Reducing Opioid Prescription After Abdominal Surgery; A Place for Nerve Block and Wound Infiltration Sameh Hany Emile1 • Medhat Mikhail Messeha2
Accepted: 30 August 2020 Ó Socie´te´ Internationale de Chirurgie 2020
Origin and extent of the opioid crisis Pain after surgery is a challenging and distressing problem that may delay patients0 recovery and predispose to a number of postoperative morbidities. Relieving postoperative pain is of utmost priority in order to expedite recovery and improve surgical outcomes. To this end, different methods are used to control postoperative pain, and one of the commonly used modalities is opioid prescription. Recently, a study [1] compared the pattern of opioid prescription after surgery in the USA and in the rest of the world. As the authors concluded, postoperative opioids are being prescribed at an alarmingly high rate in the USA. Knowing that more than 90% of the US patients received opioids postoperatively as compared to 5% of patients in other countries, this should draw more attention to halt the opioid epidemic. Furthermore, this article should be thoughtfully considered as an eye-opener study that may change some paradigms to address this challenging healthcare problem. It has been assumed that the origin of the current opioid crisis dates back to the early 1990s where undertreatment of pain was recognized as a significant clinical problem [2].
Sameh Hany Emile and Medhat Mikhail Messeha wrote and revised the manuscript. & Sameh Hany Emile [email protected] Medhat Mikhail Messeha [email protected] 1
General Surgery Department, Mansoura University Hospitals, Mansoura University, Mansoura, Egypt
2
Department of Anesthesiology, Mansoura University Hospitals, Mansoura University, Mansoura, Egypt
Most physicians presumed that patients prescribed opioids for management of pain were not vulnerable to develop opioid use disorder. This assumption was somehow correct as less than 10% of patients who receive opioids for medical reasons develop opioid use disorder. However, as the opioid prescription rates tend to increase every year and as opioids became more available, the overall prevalence of opioid use disorder has subsequently increased.
The role of anatomic nerve block In order to combat the opioid crisis, alternative measures for control of postoperative pain should be taken. One of the most clinically relevant and effective measures used for local control of postoperative pain is regional block including anatomic nerve block and wound infiltration with local anesthetics. As observed in the iPOP study [1], the procedures included to the study were appendectomy, cholecystectomy, and inguinal hernia repair, all of which can be subjected to local measures of pain control. Since the majority of these procedures are performed laparoscopically in the present time, ultrasound-guided or laparoscopic-guided anatomic nerve block can be used to control postoperative pain and reduce opioid use effectively. A recent meta-analys
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