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Preventing opioid prescription after major surgery: a scoping review of opioid-free analgesia.

Authors :
Fiore JF Jr
Olleik G
El-Kefraoui C
Verdolin B
Kouyoumdjian A
Alldrit A
Figueiredo AG
Valanci S
Marquez-GdeV JA
Schulz M
Moldoveanu D
Nguyen-Powanda P
Best G
Banks A
Landry T
Pecorelli N
Baldini G
Feldman LS
Source :
British journal of anaesthesia [Br J Anaesth] 2019 Nov; Vol. 123 (5), pp. 627-636. Date of Electronic Publication: 2019 Sep 25.
Publication Year :
2019

Abstract

Background: Excessive opioid prescribing after surgery has been recognised as a contributor to the current crisis of opioid addiction and overdose. Clinicians may potentially tackle this crisis by using opioid-free postoperative analgesia; however, the scientific literature addressing this approach is sparse and heterogeneous, thereby limiting robust conclusions. A scoping review was conducted to systematically map the extent, range, and nature of the literature addressing postoperative opioid-free analgesia.<br />Methods: Eight bibliographic databases were searched for studies addressing opioid-free analgesia after a major surgery. We extracted the study characteristics, including design, country, year, surgical procedure(s), and interventions. Results were organised thematically according to surgical specialty and targeted phase of recovery: in hospital (early recovery, ≤24 h after operation; intermediate recovery, >24 h) and post-discharge (late recovery). Reporting was according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement for scoping reviews.<br />Results: We identified 424 studies addressing postoperative opioid-free analgesia. The number of studies conducted in countries where the opioid crisis is primarily focused was remarkably low (USA, n=11 [3%]; Canada, n=5 [1%]). Many RCTs compared opioid-free vs opioid analgesia during hospital stay (n=117), but few targeted analgesia post-discharge (n=8). Studies were predominantly focused on procedures in orthopaedic, general, and gynaecological/obstetric surgery. Limited attention has been directed towards non-pharmacological pain interventions. We did not identify knowledge synthesis studies (i.e. systematic reviews and meta-analyses) focused on the comparative effectiveness of opioid-free vs opioid analgesia.<br />Conclusions: Opioids remain a mainstay analgesic for managing pain after surgery, but alternative analgesia strategies should not be overlooked. This scoping review indicates numerous opportunities for future research targeting opioid-free postoperative analgesia. REVIEW REGISTRATION: http://www.researchregistry.com; ID: reviewregistry576.<br /> (Copyright © 2019 British Journal of Anaesthesia. Published by Elsevier Ltd. All rights reserved.)

Details

Language :
English
ISSN :
1471-6771
Volume :
123
Issue :
5
Database :
MEDLINE
Journal :
British journal of anaesthesia
Publication Type :
Academic Journal
Accession number :
31563269
Full Text :
https://doi.org/10.1016/j.bja.2019.08.014