Skip to main content

American Society for Enhanced Recovery and Perioperative Quality Initiative Joint Consensus Statement on Perioperative Management of Patients on Preoperative Opioid Therapy.

Publication ,  Journal Article
Edwards, DA; Hedrick, TL; Jayaram, J; Argoff, C; Gulur, P; Holubar, SD; Gan, TJ; Mythen, MG; Miller, TE; Shaw, AD; Thacker, JKM; McEvoy, MD ...
Published in: Anesth Analg
August 2019

Enhanced recovery pathways have quickly become part of the standard of care for patients undergoing elective surgery, especially in North America and Europe. One of the central tenets of this multidisciplinary approach is the use of multimodal analgesia with opioid-sparing and even opioid-free anesthesia and analgesia. However, the current state is a historically high use of opioids for both appropriate and inappropriate reasons, and patients with chronic opioid use before their surgery represent a common, often difficult-to-manage population for the enhanced recovery providers and health care team at large. Furthermore, limited evidence and few proven successful protocols exist to guide providers caring for these at-risk patients throughout their elective surgical experience. Therefore, the fourth Perioperative Quality Initiative brought together an international team of multidisciplinary experts, including anesthesiologists, nurse anesthetists, surgeons, pain specialists, neurologists, nurses, and other experts with the objective of providing consensus recommendations. Specifically, the goal of this consensus document is to minimize opioid-related complications by providing expert-based consensus recommendations that reflect the strength of the medical evidence regarding: (1) the definition, categorization, and risk stratification of patients receiving opioids before surgery; (2) optimal perioperative treatment strategies for patients receiving preoperative opioids; and (3) optimal discharge and continuity of care management practices for patients receiving opioids preoperatively. The overarching theme of this document is to provide health care providers with guidance to reduce potentially avoidable opioid-related complications including opioid dependence (both physical and behavioral), disability, and death. Enhanced recovery programs attempt to incorporate best practices into pathways of care. By presenting the available evidence for perioperative management of patients on opioids, this consensus panel hopes to encourage further development of pathways specific to this high-risk group to mitigate the often unintentional iatrogenic and untoward effects of opioids and to improve perioperative outcomes.

Duke Scholars

Altmetric Attention Stats
Dimensions Citation Stats

Published In

Anesth Analg

DOI

EISSN

1526-7598

Publication Date

August 2019

Volume

129

Issue

2

Start / End Page

553 / 566

Location

United States

Related Subject Headings

  • Treatment Outcome
  • Time Factors
  • Terminology as Topic
  • Risk Factors
  • Risk Assessment
  • Perioperative Care
  • Pain, Postoperative
  • Pain Management
  • Opioid-Related Disorders
  • Incidence
 

Citation

APA
Chicago
ICMJE
MLA
NLM
Edwards, D. A., Hedrick, T. L., Jayaram, J., Argoff, C., Gulur, P., Holubar, S. D., … POQI-4 Working Group, . (2019). American Society for Enhanced Recovery and Perioperative Quality Initiative Joint Consensus Statement on Perioperative Management of Patients on Preoperative Opioid Therapy. Anesth Analg, 129(2), 553–566. https://doi.org/10.1213/ANE.0000000000004018
Edwards, David A., Traci L. Hedrick, Jennifer Jayaram, Charles Argoff, Padma Gulur, Stefan D. Holubar, Tong J. Gan, et al. “American Society for Enhanced Recovery and Perioperative Quality Initiative Joint Consensus Statement on Perioperative Management of Patients on Preoperative Opioid Therapy.Anesth Analg 129, no. 2 (August 2019): 553–66. https://doi.org/10.1213/ANE.0000000000004018.
Edwards, David A., et al. “American Society for Enhanced Recovery and Perioperative Quality Initiative Joint Consensus Statement on Perioperative Management of Patients on Preoperative Opioid Therapy.Anesth Analg, vol. 129, no. 2, Aug. 2019, pp. 553–66. Pubmed, doi:10.1213/ANE.0000000000004018.
Edwards DA, Hedrick TL, Jayaram J, Argoff C, Gulur P, Holubar SD, Gan TJ, Mythen MG, Miller TE, Shaw AD, Thacker JKM, McEvoy MD, POQI-4 Working Group. American Society for Enhanced Recovery and Perioperative Quality Initiative Joint Consensus Statement on Perioperative Management of Patients on Preoperative Opioid Therapy. Anesth Analg. 2019 Aug;129(2):553–566.

Published In

Anesth Analg

DOI

EISSN

1526-7598

Publication Date

August 2019

Volume

129

Issue

2

Start / End Page

553 / 566

Location

United States

Related Subject Headings

  • Treatment Outcome
  • Time Factors
  • Terminology as Topic
  • Risk Factors
  • Risk Assessment
  • Perioperative Care
  • Pain, Postoperative
  • Pain Management
  • Opioid-Related Disorders
  • Incidence