Developing expert international consensus statements for opioid-sparing analgesia using the Delphi method

Abstract

Introduction The management of postoperative pain in anaesthesia is evolving with a deeper understanding of associating multiple modalities and analgesic medications. However, the motivations and barriers regarding the adoption of opioid-sparing analgesia are not well known. Methods We designed a modified Delphi survey to explore the perspectives and opinions of expert panellists with regard to opioid-sparing multimodal analgesia. 29 anaesthetists underwent an evolving three-round questionnaire to determine the level of agreement on certain aspects of multimodal analgesia, with the last round deciding if each statement was a priority. Results The results were aggregated and a consensus, defined as achievement of over 75% on the Likert scale, was reached for five out of eight statements. The panellists agreed there was a strong body of evidence supporting opioid-sparing multimodal analgesia. However, there existed multiple barriers to widespread adoption, foremost the lack of training and education, as well as the reluctance to change existing practices. Practical issues such as cost effectiveness, increased workload, or the lack of supply of anaesthetic agents were not perceived to be as critical in preventing adoption. Conclusion Thus, a focus on developing specific guidelines for multimodal analgesia and addressing gaps in education may improve the adoption of opioid-sparing analgesia.

Can Opioid-Free Anaesthesia Be Personalised? A Narrative Review

“…Additionally, it also remains to be clarified to what extent some patients may experience, more than other patients, adverse events related to opioid-free techniques. Moreover, the context may influence implementability and safety, in particular education, sometimes more than evidence [ 79 ]. Bradycardia, for instance, has been observed when dexmedetomidine was delivered using an inappropriate protocol [ 80 ].…”

Opioid prescribing for acute postoperative pain: an overview of systematic reviews related to two consensus statements relevant at patient, prescriber, system and public health levels

“…Expert opinion can then be considered when evidence is lacking or impossible to generate. Differentiating these levels of evidence is essential to robustly secure high quality local guidance and educational programmes, which have been described as essential to implement recommendations and to confirm their local validity [ 7 ] . Sng et al graded education as the highest priority that determines the use of opioid-sparing analgesia.…”

“…But guidelines are necessary but not enough, and local guidance should consider local aspects and include educational programme, as recently considered as the highest priority in the context of multimodal, opioid-sparing, analgesia [ 7 ]. Accordingly, there have been two consensus statements published in the UK since 2020, not only relevant at patient and prescriber levels, but also at system and Public Health levels, aiming at facilitating local implementation and education.…”

Opioids and Cancer: Current Understanding and Clinical Considerations

“…Based on the premise that opioids could negatively influence prognosis in patients with cancer, opioid-free anesthesia (OFA) and opioid-sparing anesthesia techniques have been studied, described, and implemented [ 94 , 95 ]. Only one randomized controlled trial studied the effect of OFA on cancer progression after surgery.…”