• Monica W Harbell, Jonathan Cohen, Greg Balfanz, and Emily Methangkool.
• Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Phoenix, Arizona.
• Curr Opin Anaesthesiol. 2024 Dec 1; 37 (6): 697704697-704.

Purpose Of ReviewAlthough 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 FindingsOpioid-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.SummaryWe will review policy and guidelines regarding perioperative opioid management and identify challenges and future directions to mitigate opioid-related harm.Copyright © 2024 Wolters Kluwer Health, Inc. All rights reserved.

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