Bilateral Breast Reduction Without Opioid Analgesics: A Comparative Study

Parsa, Fereydoun Don; Cheng, Justin; Stephan, Brad; Castel, Nikki; Kim, Leslie; Murariu, Daniel; Parsa, Alan A.

doi:10.1093/asj/sjx038

Cited by 44 publications

(30 citation statements)

References 22 publications

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“…A Cochrane review of OFA versus opioid anesthesia found significant benefits, including the reduction of postoperative ileus [22]. Other studies have shown less postoperative pain, nausea, and vomiting [19, 23]. There are also concerns that intraoperative opioids may lead to opioid-induced hyperalgesia [24, 25].…”

Section: Discussionmentioning

confidence: 99%

Achieving Opioid-Free Major Colorectal Surgery: Is It Possible?

et al. 2020

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Introduction: Opioid analgesia remains the mainstay of postoperative pain management strategies despite being associated with many adverse effects. A specific opioid-free protocol was designed to limit opioid usage. Objective: The aim of the study was to audit the opioid-free rate within this protocol and to identify factors that might contribute to opioid-free surgery. Methods: A retrospective study of all elective patients receiving abdominal colorectal surgery at the Center for Colon and Rectal Surgery at AdventHealth over 6 months was performed. Data on demographics, indications, perioperative management, outcomes, and inpatient and outpatient analgesic requirements were collected with subsequent analysis. Results: A total of 303 consecutive patient records were analyzed. Approximately twothirds (67.7%) of patients did not receive narcotics once they left the postanesthesia care unit as an inpatient. Onethird of patients (32.0%) did not receive narcotic analgesia within 30 days of surgery as an outpatient. Patients in the opioid-free cohort were significantly older and had a malignant indication, less perioperative morbidity, and a shorter length of stay. Conclusions: Our study demonstrates that opioid-free analgesia is indeed possible in major colorectal surgery. Study limitations include its retrospective nature and that it is from a single institution. Despite these limitations, this study provides proof of concept that opioid-free colorectal surgery is possible within a specific protocol.

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Section: Discussionmentioning

confidence: 99%

Achieving Opioid-Free Major Colorectal Surgery: Is It Possible?

et al. 2020

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“…61.5%, P < .001). 20 In addition to decreased PACU opioid and antiemetic use in opioid-sparing anesthesia regimens, additional benefits include significant reductions in time to ambulation and voiding, both important factors in early discharge. 20,24 Breast cancer surgeries with shorter time to ambulation have been associated with increased emotional adjustment and decreased psychological distress to patients.…”

Section: Con Clus Ionmentioning

confidence: 99%

“…20 In addition to decreased PACU opioid and antiemetic use in opioid-sparing anesthesia regimens, additional benefits include significant reductions in time to ambulation and voiding, both important factors in early discharge. 20,24 Breast cancer surgeries with shorter time to ambulation have been associated with increased emotional adjustment and decreased psychological distress to patients. 25,26 From a breast cancer patient perspective, OFA protocols have demonstrated improved emotional and psychological recovery, in part due to minimizing postoperative cognitive dysfunction.…”

Section: Con Clus Ionmentioning

confidence: 99%

Opioid‐free anesthesia for patients undergoing mastectomy: A matched comparison

et al. 2020

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Between 1997 and 2002, the sale of oxycodone and methadone quadrupled, spurred by the introduction of pain as the fifth vital sign and pharmaceutical marketing efforts. 1 Concepts such as "staying ahead of the pain" and implementation of quality metrics relating to pain scores led to overzealous opioid prescribing, precipitating the current opioid crisis. Hundreds die daily as a result of overdose, with upwards of 40% directly related to opioid prescription. 2 As a result, the US Department of Health and Human Services has declared a public health emergency. 3 In 2018, the US mortality from opioid overdose surpassed breast cancer mortality. 4 The Substance Use-Disorder Prevention that Promotes Opioid Recovery and Treatment (SUPPORT) act was passed with bipartisan support in 2018, highlighting the critical nature of research, education, and training to combat the opioid epidemic. 5 Emerging evidence suggests a correlation with the amount of narcotics used and

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“…Sugai et al demonstrated that preoperative oral and written education concerning the body's response to pain reduced preoperative and postoperative opioid prescriptions [18]. When comparing patients that had opioid-free procedures to the patients receiving adjunct opioids, Parsa et al found statistically significant reduction in time from end of operation to discharge, unplanned postoperative hospital admissions, and opioid use in the post-anesthesia care unit [19].…”

Section: Opioid Alternatives For Postoperative Pain Controlmentioning

confidence: 99%

From the Origins of the Opioid Use (and Misuse) to the Challenge of Opioid-Free Pain Management in Surgery

Yim¹,

Parsa²

2019

From Conventional to Innovative Approaches for Pain Treatment

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Pain is a physiologic mechanism of the human body. Early cultures believed pain to have demonic and spiritual origins. In the early nineteenth century, morphine was first isolated by the German pharmacist Friedrich Wilhelm Adam Ferdinand Serturner. Since then, synthetic opioids and other derivatives of morphine have been developed for a wide variety of purposes, including pain relief during surgery. Opioids mainly act through the stimulation of μ-receptors, which has inhibitory effects on the propagation of pain signals to the brain. However, opioids also have unwanted side effects like nausea, vomiting, constipation, postoperative sedation, dizziness, and addiction, and are associated with significant morbidity, prolong hospital stays, increase use of medications needed to reverse side effects, and decrease patient satisfaction. Furthermore, use and abuse of opioids have contributed to an opioid epidemic, especially in the United States since the beginning of the twenty-first century. Opioid-free anesthesia is an alternative aimed at providing pain relief without the opioid-related adverse effects and to enhance recovery. Non-opioid alternatives and preoperative patient education strategies have been shown to be superior in the management of postoperative pain and opioid requirements. Clinicals have embraced these concepts enthusiastically and have begun to incorporate an opioid-free pain management approach in surgery.

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Bilateral Breast Reduction Without Opioid Analgesics: A Comparative Study

Abstract: 3.

Cited by 44 publications

References 22 publications

Achieving Opioid-Free Major Colorectal Surgery: Is It Possible?

Achieving Opioid-Free Major Colorectal Surgery: Is It Possible?

Opioid‐free anesthesia for patients undergoing mastectomy: A matched comparison

From the Origins of the Opioid Use (and Misuse) to the Challenge of Opioid-Free Pain Management in Surgery

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