Articles: opioid-analgesics.
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A remifentanil infusion dose of >0.2 μg/kg/min is associated with hyperalgesia, leading to acute postsurgical pain; however, its contribution to the development of chronic postsurgical pain after video-assisted thoracic surgery remains unclear. This study aimed to evaluate the impact of different remifentanil doses on chronic postsurgical pain after video-assisted thoracic surgery. This study included inpatients aged ≥ 55 years who underwent video-assisted thoracic surgery under general anesthesia between April 2016 and December 2018. ⋯ Chronic postsurgical pain occurred in 23.6% of patients. The generalized estimating equation revealed that a remifentanil infusion dose >0.2 μg/kg/min was associated with chronic postsurgical pain at 1 year after surgery (odds ratio [OR] 1.52; 95% confidence interval [CI] 1.03-2.27), while remifentanil infusion doses >0.15 μg/kg/min (OR 1.12; 95% CI 0.79-1.59) and >0.175 μg/kg/min (OR 1.17; 95% CI 0.83-1.64) were not associated with our primary outcome. Remifentanil infusions >0.2 μg/kg/min were associated with chronic postsurgical pain 1 year after video-assisted thoracic surgery.
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Opioids are often a mainstay of managing postsurgical pain. Persistent use of opioids for more than 90 days after surgery is problematic, and the incidence of this adverse outcome has been reported in the civilian population ranging from 0.4% to 7%. Veterans compose a special population exposed to trauma and stressful situations and consequently face increased risk for habit-forming behavior and drug overdose. This evaluation determined the prevalence of opioid persistence after surgery and its relationship to patient characteristics in a military veteran population. ⋯ Among a cohort of over 1,200 opioid-naïve veterans undergoing surgery at a VA Medical Center, just over 3% went on to develop persistent opioid use beyond 3 months following their procedure. Persistent use was not found to be related to the type of procedure (major or minor) or patient age. Significant patient-level risk factors for opioid persistence were cancer and a history of mental health and substance use disorders.
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Randomized Controlled Trial
Opioid analgesia for acute low back pain and neck pain (the OPAL trial): a randomised placebo-controlled trial.
Opioid analgesics are commonly used for acute low back pain and neck pain, but supporting efficacy data are scarce. We aimed to investigate the efficacy and safety of a judicious short course of an opioid analgesic for acute low back pain and neck pain. ⋯ National Health and Medical Research Council, University of Sydney Faculty of Medicine and Health, and SafeWork SA.
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Practice Guideline
Clinical practice guideline for deprescribing opioid analgesics: summary of recommendations.
Long term opioids are commonly prescribed to manage pain. Dose reduction or discontinuation (deprescribing) can be challenging, even when the potential harms of continuation outweigh the perceived benefits. The Evidence-based clinical practice guideline for deprescribing opioid analgesics was developed using robust guideline development processes and Grading of Recommendations, Assessment, Development and Evaluation (GRADE) methodology, and contains deprescribing recommendations for adults prescribed opioids for pain. ⋯ To our knowledge, these are the first evidence-based guidelines for opioid deprescribing. The recommendations intend to facilitate safe and effective deprescribing to improve the quality of care for persons taking opioids for pain.