Articles: opioid.
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Reg Anesth Pain Med · Jan 2025
Impact of preoperative opioid exposure on cost of care and workplace productivity loss after elective surgery.
A high proportion of surgical patients has previous opioid exposure, which is associated with poorer recovery and increased morbidity. However, much less is known regarding the direct and indirect costs that are associated with healthcare utilization among individuals on preoperative opioid therapy. ⋯ High preoperative opioid use is associated with increased healthcare utilization and costs following common elective surgery. Future efforts should focus on this patient population to explore interventions that could optimize value-based care by improving outcomes and reducing costs.
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Objective: We present a case of a patient with an intrathecal pump who experienced an unrecognized partial pocket fill, leading to an atypical opioid withdrawal characterized by akathisia. Case Report: A 57-year-old female with multiple myeloma presented to an emergency department with new-onset akathisia requiring admission. Eight weeks prior, her intrathecal pump was refilled with morphine, bupivacaine, and ziconotide. ⋯ Furthermore, she reported sedation following her last pump refill, all consistent with an unrecognized partial pocket fill followed by an unusual opioid withdrawal presentation. Conclusions: This case represents an example of both an unrecognized partial pocket fill and an atypical presentation of opioid withdrawal manifesting as akathisia. Furthermore, this patient's case may be considered a medical error given the serious morbidity that can be associated with inadvertent pocket fills.
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Optimising a mother's quality of recovery following caesarean delivery is of paramount importance as it facilitates maternal care of the newborn and affects physical, psychological and emotional well being. Intrathecal morphine (ITM) reduces postoperative pain and may improve quality of recovery: however its widespread use is limited. ⋯ Implementing ITM for caesarean delivery resulted in moderate improvements in obstetric recovery and reduced opioid consumption. Cautious interpretation is warranted given the nonrandomised design of this implementation study. Our findings support the use of ITM in a multimodal analgesia strategy for patients undergoing caesarean delivery.
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Anesthesia and analgesia · Jan 2025
Patients' Experiences With Opioid Tapering in Noncancer Pain: A Systematic Review and Meta-synthesis.
Tapering opioids is an effective strategy to reduce the risks associated with long-term opioid therapy. However, patients' experience with tapering can influence the success of this treatment. Understanding patients' experiences with opioid tapering will allow for patient-centered approaches to be adopted to tailor interventions to achieve safe and successful taper outcomes. ⋯ Three key themes guiding the new meta-synthesis were identified: (1) patient-provider interactions, (2) individualized care, and (3) tactics to manage the opioid tapering process. This review demonstrated the role that patient-provider interactions, tailored care, and effective tapering strategies play in facilitating a favorable patient experience during the opioid tapering process. Future research should incorporate the themes identified in this review to optimize the patient's taper experience.