British journal of anaesthesia
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Review
The prescription opioid crisis: role of the anaesthesiologist in reducing opioid use and misuse.
Why should I care?
Misuse of opioids is a growing global problem, well established in the US and quickly appearing in many high-resource countries. One person dies every 15 minutes in the US from opioid overdose.
For many affected, the perioperative period is the first exposure event. In the US ~6% of previously opioid-naive patients progress to persistent opioid use after surgery.
What can anaesthetists and anesthesiologists do?
- Identify patients at risk of opioid dependence.
- Use multi-modal non-opioid analgesia perioperatively.
- Educate patients on realistic expectations for post-operative pain.
- Consider regional techniques intraoperatively when appropriate.
- Limit discharge prescribing of opioids (42-71% of all postop opioid tablets go unused!).
The bigger picture...
Although inidividual practice changes are important, real impact will come through anesthesiologists as integrators of care (eg. ERAS interventions) and contributions to institutional strategies, patient and provider education.
Take a long view, this problem is not going away in a hurry...
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Clinical Trial
Subjective cognitive complaints in patients undergoing major non-cardiac surgery: a prospective single centre cohort trial.
Few perioperative studies have assessed subjective cognitive complaint (SCC) in combination with neuropsychological testing. New nomenclature guidelines require both SCC and objective decline on cognitive testing. The objective of our study was to compare SCC and neuropsychological testing in an elderly surgical cohort. ⋯ NCT02650687.
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Randomized Controlled Trial Multicenter Study
Multicentre, prospective, double-blind, randomised controlled clinical trial comparing different non-opioid analgesic combinations with morphine for postoperative analgesia: the OCTOPUS study.
Head-to-head comparisons of combinations of more than one non-opioid analgesic (NOA) with morphine alone, for postoperative analgesia, are lacking. The objective of this multicentre, randomised, double-blind controlled trial was to compare the morphine-sparing effects of different combinations of three NOAs-paracetamol (P), nefopam (N), and ketoprofen (K)-for postoperative analgesia. ⋯ EudraCT: 2012-004219-30; NCT01882530.
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Randomized Controlled Trial Multicenter Study Comparative Study
Satisfactory analgesia with minimal emesis in day surgeries: a randomised controlled trial of morphine versus hydromorphone.
Opioids remain the mainstay therapy for post-surgical pain. Although both morphine and hydromorphone are potent analgesics, it has been suggested that hydromorphone is clinically better. Our primary objective was to compare morphine with hydromorphone for achieving satisfactory analgesia with minimal emesis (SAME). ⋯ NCT02223377.