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Evolving the management of acute perioperative pain towards opioid free protocols: a narrative review.

Publication ,  Journal Article
Nassif, GJ; Miller, TE
Published in: Curr Med Res Opin
December 2019

Objective: Identification of pain as the fifth vital sign has resulted in over-prescription and overuse of opioids in the US, with addiction reaching epidemic proportions. In Europe, and more recently in the US, a shift has occurred with the global adoption of multimodal analgesia (MMA), which seeks to minimize perioperative opioid use. Improved functional outcomes and reduced healthcare utilization costs have been demonstrated with MMA, but wide scale use of opioids in pain management protocols continues. As a next step in the pain management evolution, opioid-free analgesia (OFA) MMA strategies have emerged as feasible in many surgical settings.Methods: Articles were limited to clinical studies and meta-analyses focusing on comparisons between opioid-intensive and opioid-free/opioid-sparing strategies published in English.Results: In this review, elimination or substantial reduction in opioid use with OFA strategies for perioperative acute pain are discussed, with an emphasis on improved pain control and patient satisfaction. Improved functional outcomes and patient recovery, as well as reduced healthcare utilization costs, are also discussed, along with challenges facing the implementation of such strategies.Conclusions: Effective MMA strategies have paved the way for OFA approaches to postoperative pain management, with goals to reduce opioid prescriptions, improve patient recovery, and reduce overall healthcare resource utilization and costs. However, institution-wide deployment and adoption of OFA is still in early stages and will require personalization and better management of patient expectations.

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Published In

Curr Med Res Opin

DOI

EISSN

1473-4877

Publication Date

December 2019

Volume

35

Issue

12

Start / End Page

2129 / 2136

Location

England

Related Subject Headings

  • Pain, Postoperative
  • Pain Management
  • Opioid Epidemic
  • Medical Overuse
  • Humans
  • General & Internal Medicine
  • Analgesics, Opioid
  • Analgesia
  • Acute Pain
  • 4003 Biomedical engineering
 

Citation

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Nassif, G. J., & Miller, T. E. (2019). Evolving the management of acute perioperative pain towards opioid free protocols: a narrative review. Curr Med Res Opin, 35(12), 2129–2136. https://doi.org/10.1080/03007995.2019.1646001
Nassif, George J., and Timothy E. Miller. “Evolving the management of acute perioperative pain towards opioid free protocols: a narrative review.Curr Med Res Opin 35, no. 12 (December 2019): 2129–36. https://doi.org/10.1080/03007995.2019.1646001.
Nassif GJ, Miller TE. Evolving the management of acute perioperative pain towards opioid free protocols: a narrative review. Curr Med Res Opin. 2019 Dec;35(12):2129–36.
Nassif, George J., and Timothy E. Miller. “Evolving the management of acute perioperative pain towards opioid free protocols: a narrative review.Curr Med Res Opin, vol. 35, no. 12, Dec. 2019, pp. 2129–36. Pubmed, doi:10.1080/03007995.2019.1646001.
Nassif GJ, Miller TE. Evolving the management of acute perioperative pain towards opioid free protocols: a narrative review. Curr Med Res Opin. 2019 Dec;35(12):2129–2136.

Published In

Curr Med Res Opin

DOI

EISSN

1473-4877

Publication Date

December 2019

Volume

35

Issue

12

Start / End Page

2129 / 2136

Location

England

Related Subject Headings

  • Pain, Postoperative
  • Pain Management
  • Opioid Epidemic
  • Medical Overuse
  • Humans
  • General & Internal Medicine
  • Analgesics, Opioid
  • Analgesia
  • Acute Pain
  • 4003 Biomedical engineering