A Practical Approach to Acute Postoperative Pain Management in Chronic Pain Patients

Aroke, Edwin N.; McMullan, Susan P.; Woodfin, Katie O.; Richey, Ryan; Doss, Jordan; Wilbanks, Bryan A

doi:10.1016/j.jopan.2020.03.002

Cited by 7 publications

(4 citation statements)

References 62 publications

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“…For patients who are admitted for trauma or other conditions requiring surgery, full agonist opioids may be required for both pain and withdrawal management. 30,31 Low dose with overlap induction provides an alternative to abrupt full agonist discontinuation. Apart from withdrawal symptoms reported by a minority of patients, we did not identify any documented adverse events associated with the transitions, and over the oneyear study period a substantial number of patients chose to attempt this approach.…”

Section: Discussionmentioning

confidence: 99%

Low Dose Buprenorphine Induction With Full Agonist Overlap in Hospitalized Patients With Opioid Use Disorder: A Retrospective Cohort Study

Bhatraju

Klein

Hall

et al. 2021

Journal of Addiction Medicine

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ObjectiveTo describe the outcomes of buprenorphine/naloxone low dose induction with overlap of full opioid agonists among hospitalized patients with opioid use disorder (OUD) as an alternative to standard induction strategies.MethodsRetrospective cohort study of patients with OUD who were admitted to the hospital over a 1-year period and initiated ono buprenorphine using initial doses of 0.5 mg and gradually increased while the patient remained on full agonists. Descriptive variables included basic demographics, reason for switching to buprenorphine, baseline opioid and morphine equivalent dose. The primary outcome was a successful transition defined by the patient leaving the hospital with a buprenorphine prescription. Bivariate analysis identified factors associated with unsuccessful medication transitions. Secondary outcomes included reported withdrawal symptoms and 30 day follow up to an outpatient buprenorphine program.ResultsSixty two patients underwent low dose with overlap induction during the study period. Fourteen patients were on methadone for OUD before hospital admission. Fifty one patients (82%) successfully left the hospital with a prescription for buprenorphine. Factors associated with lower likelihood of success included older age, transitioning due to discharge placement needs and presence of withdrawal symptoms during the transition. Overall, 66% (N = 23) of patients referred within the same health care system followed up within 30 days.ConclusionsLow dose inductions with overlap of full opioid agonists were largely successful in transitioning hospitalized patients from full agonist opioids to buprenorphine. However, there were several factors associated with lower likelihood of success. Future work could focus on treatment of withdrawal symptoms and system-level changes ensuring patient-centered medication decisions.

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Section: Discussionmentioning

confidence: 99%

Low Dose Buprenorphine Induction With Full Agonist Overlap in Hospitalized Patients With Opioid Use Disorder: A Retrospective Cohort Study

Bhatraju

Klein

Hall

et al. 2021

Journal of Addiction Medicine

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“…It is well established that perioperative pain management can be challenging in nonopioid-naive patients, and concerns have been raised regarding possible undertreatment of acute postoperative pain in chronic opioid users. 14 , 15 Although the rationale for the association between prior opioid prescription and improved protocol adherence is unclear, we hypothesize that knowledge of a patient’s recent opioid prescription(s)—whether obtained via chart review or review of a state-based prescription monitoring database—may lead to provider wariness of contributing to the development of dependence and therefore increased likelihood of provider adherence to the standardized protocol. It is also possible that knowledge of a recent opioid prescription may lead some providers to assume the patient has leftover opioids or a patient may communicate this to the provider directly, leading to a smaller postoperative prescription.…”

Section: Discussionmentioning

confidence: 99%

Evaluating Prescriber Adherence to a Standardized Postoperative Opioid Prescription Protocol for Cubital Tunnel Surgery

Giberson-Chen,

Liu,

Grisdela

et al. 2024

Journal of Hand Surgery Global Online

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“…Celý výpočet i s kalkulací dávek nejčastěji podávaných opioidů je k dispozici i v češtině [30]. Zvlášť je uveden postup léčba pooperační bolesti u pacientů na udržovací terapii metadonem, buprenorfinem a naltrexonem [29]. Na konci je publikováno několik příkladů při plánování terapie u pacientů s chronickou bolestí v perioperačním období [29].…”

Section: Léčba Bolesti V Době Epidemie Covid-19unclassified

Year 2020 in review - Perioperative pain therapy

Málek¹

2020

Anest. intenziv. Med.

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Článek přináší vybraný přehled prací a témat, která byla v oblasti léčby především akutní bolesti publikována za poslední rok. Věnuje se novinkám v systémové analgezii, organizaci léčby bolesti a vybraným mezinárodním doporučením.Klíčová slova: analgezie, chronická pooperační bolest, mezinárodní doporučení, ketamin, gabapentinoidy, opioidy. year 2020 in review -perioperative pain therapyThe article highlights and discusses several current topics that have been published in the field of acute pain therapy last year. It summarizes the current publications concerning systemic analgesia, organisation of pain therapy and international guidelines concerning acute pain therapy.

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A Practical Approach to Acute Postoperative Pain Management in Chronic Pain Patients

Cited by 7 publications

References 62 publications

Low Dose Buprenorphine Induction With Full Agonist Overlap in Hospitalized Patients With Opioid Use Disorder: A Retrospective Cohort Study

Low Dose Buprenorphine Induction With Full Agonist Overlap in Hospitalized Patients With Opioid Use Disorder: A Retrospective Cohort Study

Evaluating Prescriber Adherence to a Standardized Postoperative Opioid Prescription Protocol for Cubital Tunnel Surgery

Year 2020 in review - Perioperative pain therapy

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