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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As we follow the national opioid epidemic, with its greater than five deaths per hour from opioid overdoses, the focus is shifting to methods for limiting an individual’s exposure to these drugs. For most of us, our first contact with these highly addictive medications is after surgery. Studies now reveal that 60 percent of pills prescribed for pain after surgery go unused. These opioids often make their way to other family members, are kept for continued use by the surgical patient to maintain a feeling of euphoria, or even find their way out into the community. Limiting the number of pills and refills prescribed is...
Source: Kevin, M.D. - Medical Weblog - Category: General Medicine Authors: Tags: Conditions Surgery Source Type: blogs
A guest column by the American Society of Anesthesiologists, exclusive to KevinMD.com. Every physician takes the Hippocratic oath and promises to “do no harm.” In the face of the current opioid epidemic, this includes protecting our patients from dependence and addiction, including those who are suffering from debilitating acute and chronic pain. Sometimes this involves getting creative as we develop treatment plans. Luckily, opioids are not the only, nor always the best, defense against pain. One patient who avoided the negative side effects of long-term opioid use was Beth Hunt. Beth was living life...
Source: Kevin, M.D. - Medical Weblog - Category: General Medicine Authors: Tags: Conditions Pain Management Surgery Source Type: blogs
Conclusions: In a population at risk for persistent opioid use, prescription often exceeds patients’ needs. Guidelines for opioid prescribing in the setting of multimodal anesthetic regimens may allow us to lessen our contribution to the opioid epidemic. Further research on patients with chronic pain, patients with chronic opioid use, and the role of patient education is needed.
Source: Journal of Minimally Invasive Gynecology - Category: OBGYN Source Type: research
The use of neurostimulation could be an effective weapon in the long fight to eliminate the opioid epidemic in the U.S. FDA just recently signed off on a neurostimulation pain treatment therapy from SPR Therapeutics. The Cleveland-based company said it has received clearance to market the Sprint extensa (dual lead) Peripheral Nerve Stimulation (PNS) System. The company also received clearance for some updated features on its single lead pain treatment application. “This recent clearance allows now for a dual lead or two lead to be used in the treatment of pain and it allows us to target just more than one...
Source: MDDI - Category: Medical Devices Authors: Tags: Business Source Type: news
SPR Therapeutics, a Cleveland, Ohio firm, landed clearance from the FDA for its SPRINT endura  and extensa peripheral nerve stimulators (PNS). The endura is a single lead system, while the extensa is dual lead. The two devic...
Source: Medgadget - Category: Medical Devices Authors: Tags: Anesthesiology Medicine Pain Management acutepain chronicpain Source Type: blogs
Low back pain, despite the multitude of explanations and increasing disability associated with it, has been with humans since forever. Who knows why and I’m not about to conjecture. What’s interesting is that despite ergonomic solutions (fail), increased fitness amongst many people (also a fail), surgical solutions (fail), hands on solutions (fail, fail), and a whole bunch of “special” exercises (fail, fail, fail) we still don’t have a handle on how to reduce disability from it. I don’t think there will be many people who haven’t seen this: I’ve never quite worked out why, w...
Source: HealthSkills Weblog - Category: Anesthesiology Authors: Tags: Back pain Low back pain Pain conditions Research biopsychosocial Chronic pain Clinical reasoning disability pain management Therapeutic approaches Source Type: blogs
A guest column by the American Society of Anesthesiologists, exclusive to KevinMD.com. Chronic pain is a silent epidemic Chronic pain is a significant public health burden, but one that is not talked about enough. In 2011, the Institute of Medicine estimated that approximately 100 million Americans suffer from chronic pain. But chronic pain is not just a national problem. The 2016 World Health Organization (WHO) Global Burden of Disease report named back pain as the leading cause of years lived with disability (YLD), or more simply stated, years not being able to live your best life. Chronic pain is a complex dis...
Source: Kevin, M.D. - Medical Weblog - Category: General Medicine Authors: Tags: Conditions Pain Management Primary Care Source Type: blogs
Purpose of review This review summarizes evolving knowledge regarding adverse maternal, fetal, and neonatal effects of opioid exposure during pregnancy, and current treatment options for opioid use disorder (OUD). Maternal and fetal implications of maternal opioid maintenance with methadone and buprenorphine are described. Finally, acute and chronic pain management strategies in opioid-tolerant parturients are reviewed. Recent findings Opioid use among parturients has risen dramatically, with opioid use during pregnancy as high as 20%. Of women with chronic pain, most continue to take opioids during pregnancy. Medicat...
Source: Current Opinion in Anaesthesiology - Category: Anesthesiology Tags: OBSTETRIC AND GYNECOLOGICAL ANESTHESIA: Edited by Jeanette Bauchat Source Type: research
Providers face many challenges when faced with pain management. Pain is complex, difficult to understand, diagnose, and especially enigmatic to manage. The discovery of non-opioid agents for pain management has become particularly important considering the on-going opioid epidemic. This review is focused on revisiting Ketamine, an agent that has historically been used for anesthesia in new ways to manage pain. Ketamine has unique pharmacologic properties that may prevent the development of pain as well as reduce chronic pain.
Source: The American Journal of Medicine - Category: General Medicine Authors: Tags: Review Source Type: research
Providers face many challenges when faced with pain management. Pain is complex, difficult to understand and diagnose, and especially enigmatic to manage. The discovery of nonopioid agents for pain management has become particularly important considering the ongoing opioid epidemic. This review is focused on revisiting ketamine, an agent that has historically been used for anesthesia, in new ways to manage pain. Ketamine has unique pharmacologic properties that may prevent the development of pain as well as reduce chronic pain.
Source: The American Journal of Medicine - Category: General Medicine Authors: Tags: Review Source Type: research
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