Anesthesia in the News
  • Reducing Opioid Use in the Perioperative Period

    To help mitigate the opioid epidemic, researchers suggest alternative nonopioid strategies to treat perioperative patient pain.

    Nurse anesthetists, perianesthesia nurses, anesthesiologists, and surgeons must all be aware of the severity of the ongoing and worsening US opioid epidemic and how to manage pain while minimizing the use of opioids, according to a recent paper.

    The ‘lives lost’ toll

    The four CRNA authors point out that, according to 2016 and 2017 data from the US Department of Health and Human Services (HHS), an estimated 130 people per day died from opioid-related drug overdoses; 42,249 people died from overdosing on opioids; and 2.1 million people had opioid-use disorder.

    What works for opioid alternatives?

    To help mitigate the epidemic, the authors suggest that medical personnel use alternative nonopioid (or low-opioid) strategies to treat perioperative patient pain. With regard to enhanced recovery after surgery (ERAS) analgesic management, they note, analgesia using nonopioid and low-dose opioid techniques has been demonstrated to be adequate using a multimodal approach focused on actions and measures to reduce surgical stress, improve hemodynamic function, and reduce time to mobilization postoperatively.

    Local anesthetics — which block signal transduction of pain — when combined with regional nerve blocks cover most surgical procedures and decrease reliance on narcotics.

    Going multimodal

    NSAIDS, ketorolac, and acetaminophen, all of which target disruption of prostaglandin synthesis, may be used aside from or in conjunction with opioids as part of the multimodal model.

    Adjuvant pharmacologic classes include gabapentenoids, NMDA receptor antagonists, alpha-2 adrenergic agonists, glucocorticoids, selective cyclooxygenase-2 (COX-2) inhibitors, and others. The authors note that studies show that many of these agents correlate with decreased opioid-induced side effects and postanesthesia care unit lengths of stay.

    Alternate approaches

    Nonpharmacologic pain therapies also exist, but may not be as effective in controlling postoperative pain. These include massage, acupuncture/acupressure, cold therapy, transcutaneous electrical nerve stimulation, cognitive behavioral modalities (such as hypnosis and guided imagery), and music therapy.

    The authors conclude that interprofessional communication and collaboration among medical personnel “are vital to ensure safe evidence-based pain management.”

    Read your CRNA colleagues’ full paper, Everson M, McLain N, Collins MJ, Rayborn M. Perioperative pain management strategies in the age of an opioid epidemic. J Perianesth Nurs. 2020 Aug;35(4):347-352 at