Mitigating and preventing perioperative opioid-related harm.

Purpose of review

Although necessary for treatment of acute pain, opioids are associated with significant harm in the perioperative period and further intervention is necessary perioperatively to mitigate opioid-related harm.

Recent findings

Opioid-naive patients are often first exposed to opioids when undergoing surgery, which can result in significant harm. Despite their benefits in reducing acute postsurgical pain, they are also associated with risks ranging from mild (e.g., pruritis, constipation, nausea) to potentially catastrophic (e.g. opioid-induced ventilatory impairment, respiratory depression, death). Overprescribing of opioids can lead to opioid diversion and drug driving. In this review, we will discuss opioid-related harm and what strategies can be used perioperatively to mitigate this harm. Interventions such as optimizing nonopioid analgesia, implementing Enhanced Recovery after Surgery programs, effective respiratory monitoring, patient education and opioid stewardship programs will be discussed.

Summary

We will review policy and guidelines regarding perioperative opioid management and identify challenges and future directions to mitigate opioid-related harm.

References:

• Neuman MD, Bateman BT, Wunsch H. Inappropriate opioid prescription after surgery. Lancet 2019; 393:1547–1557.
• Burns ML, Hilliard P, Vandervest J, et al. Variation in intraoperative opioid administration by patient, clinician, and hospital contribution. JAMA Netw Open 2024; 7:e2351689.
• World Health Organization. Opioid overdose. 2023. Available at: https://www.who.int/news-room/fact-sheets/detail/opioid-overdose .
• National Institute on Drug Abuse. Drug overdose death rates. 2024. Available at: https://nida.nih.gov/research-topics/trends-statistics/overdose-death-rates .
• Larach DB, Waljee JF, Hu H-M, et al. Patterns of initial opioid prescribing to opioid-naive patients. Ann Surg 2020; 271:290–295.