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Impact of Enhanced Recovery After Surgery and Opioid-Free Anesthesia on Opioid Prescriptions at Discharge From the Hospital: A Historical-Prospective Study.

CONCLUSIONS: This study is the first to report discharge opioid prescribing practices in an ERAS setting. Although an ERAS intervention for colorectal surgery led to an increase in opioid-free anesthesia and multimodal analgesia, we did not observe an impact on discharge opioid prescribing practices. The majority of patients were discharged with an opioid prescription, including those with a combination of low discharge pain scores, no preoperative opioid use, and low morphine milligram equivalents consumption before discharge. This observation in the setting of an ERAS pathway that promotes multimodal analgesia suggests that our findings are very likely to also be observed in non-ERAS settings and offers an opportunity to modify opioid prescribing practices on discharge after surgery. For opioid-free anesthesia and multimodal analgesia to influence the opioid epidemic, the dose and quantity of the opioids prescribed should be modified based on the information gathered by in-hospital pain scores and opioid use as well as pain history before admission. PMID: 29049123 [PubMed - in process]
Source: Anesthesia and Analgesia - Category: Anesthesiology Authors: Tags: Anesth Analg Source Type: research

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Abstract An overreliance on opioids has impacted all types of pain management, making it undoubtedly a root cause of the "epidemic" of prescription opioid abuse in the United States. Yet, an examination of the statistics that led the US Centers for Disease Control and Prevention to declare that prescription opioid abuse had reached epidemic levels shows that the abuse occurrences and deaths are arising outside the hospital or hospice setting, which strongly implicates the outpatient use of opioids to treat chronic pain. Such abuse and related deaths are occurring in chronic pain patients themselves and a...
Source: Anesthesia and Analgesia - Category: Anesthesiology Authors: Tags: Anesth Analg Source Type: research
Abstract Physicians, policymakers, and researchers are increasingly focused on finding ways to decrease opioid use and overdose in the United States both of which have sharply increased over the past decade. While many efforts are focused on the management of chronic pain, the use of opioids in surgical patients presents a particularly challenging problem requiring clinicians to balance 2 competing interests: managing acute pain in the immediate postoperative period and minimizing the risks of persistent opioid use after the surgery. Finding ways to minimize this risk is particularly salient in light of a growing ...
Source: Anesthesia and Analgesia - Category: Anesthesiology Authors: Tags: Anesth Analg Source Type: research
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Source: Anesthesia and Analgesia - Category: Anesthesiology Authors: Tags: Anesth Analg Source Type: research
Abstract The United States is in the midst of a devastating opioid misuse epidemic leading to over 33,000 deaths per year from both prescription and illegal opioids. Roughly half of these deaths are attributable to prescription opioids. Federal and state governments have only recently begun to grasp the magnitude of this public health crisis. In 2016, the Centers for Disease Control and Prevention released their Guidelines for Prescribing Opioids for Chronic Pain. While not comprehensive in scope, these guidelines attempt to control and regulate opioid prescribing. Other federal agencies involved with the federal ...
Source: Anesthesia and Analgesia - Category: Anesthesiology Authors: Tags: Anesth Analg Source Type: research
Abstract As the United States experiences an epidemic of prescription drug abuse, and guidelines on safe practices in prescribing opioids in chronic pain have subsequently emerged from professional organizations and governmental agencies, limited guidance exists for prescribers of opioids to treat pain in patients with cancer or terminal illness. Patients with active cancer or terminal illness often have pain and are frequently prescribed opioids and other controlled substances. Current studies suggest that patients with cancer have similar rates of risk for misuse, abuse, and addiction as the general public. More...
Source: Anesthesia and Analgesia - Category: Anesthesiology Authors: Tags: Anesth Analg Source Type: research
On September 8, 1854, acting on the advice of Dr. John Snow, London municipal authorities removed the pump handle from the Broad Street well in an effort to halt a major outbreak of cholera. Although an anesthesiologist by profession, Snow had methodically mapped the homes of new cases of cholera. He found that many clustered around the Broad Street pump. Snow’s findings, still regarded as a classic example of epidemiology, established the principle: “that the most important information to have about any communicable disease is its mode of communication.” Dr. Snow did not establish the biologic mechanism ...
Source: Health Affairs Blog - Category: Health Management Authors: Tags: Featured Public Health Quality Department of Veterans Affairs military health care Opioid Addiction opioid epidemic Source Type: blogs
On May 25, the Interagency Pain Research Coordinating Committee (IPRCC) and the Office of Pain Policy of the National Institutes of Health (NIH) released draft Federal Pain Research Priorities, which were presented and discussed at a forum and public comment period on June 1. The forum immediately followed the Annual NIH Pain Consortium Symposium, where presentations highlighted multidisciplinary strategies for the management of pain. Following the open public comment period, written comments will be accepted until June 6.The Federal Pain Research Strategy (FPRS) is an effort to oversee development...
Source: Psychology of Pain - Category: Anesthesiology Source Type: blogs
In 2012, FDA instituted a risk evaluation and mitigation strategy (REMS) for extended-release and long-acting (ER/LA) opioids that required companies marketing ER/LA opioids to provide a medication guide and make training available to prescribers. Under the REMS, the training must be provided by accredited providers and cover all elements of the agency's Blueprint for Prescriber Education for Extended-Release and Long-Acting Opioid Analgesics. However, while the agency set goals for prescriber participation, prescribers were not required under the REMS to go through with the training. On May 9th and 10th, 2017, the ...
Source: Policy and Medicine - Category: American Health Authors: Source Type: blogs
AbstractPurpose of ReviewThe current opioid epidemic in North America has directed trends in acute pain management towards complementary therapies, including nonopioid analgesics and regional anesthesia techniques. More recently neurostimulation has reappeared as an alternative therapy. Neurostimulation has been used for many years as an analgesic modality in the treatment of a variety of acute and chronic pain conditions. However, available technologies previously limited its widespread use. More recently, percutaneous peripheral nerve stimulation (pPNS) has been suggested as a means to help manage acute postoperative pai...
Source: Current Anesthesiology Reports - Category: Anesthesiology Source Type: research
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Source: Journal of Clinical Anesthesia - Category: Anesthesiology Authors: Tags: Case report Source Type: research
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