Hospital opioid use predicts the need for discharge opioid prescriptions following laparoscopic bariatric surgery

Diaz, Sarah E.; Dandalides, Alissa; Carlin, Arthur M.

doi:10.1007/s00464-022-09035-x

Cited by 9 publications

(4 citation statements)

References 19 publications

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“…[ 1 2 ] Additionally, certain patients have pre-existing risk factors for poorly controlled acute pain - chronic pain, chronic opioid use, substance abuse, complex psychiatric history, or previous experience of poorly controlled pain [ Table 1 ]. [ 9 10 11 12 13 14 ] These subsets of patients often have a perioperative escalation of their opioid requirements and hence should be meticulously screened and tested for OSA. Many of these patients will need specialist consultations for their pain before elective surgery and plan for extended postoperative stay with appropriate level and duration of monitoring.…”

Section: Preoperative Preparationmentioning

confidence: 99%

“…The evidence thus far supports preoperative education and prehabilitation, implementation of ERAS programs, and the use of structured pain management protocols. [ 9 10 11 12 13 14 ] Therefore, perioperative pain-related interventions have benefits beyond early discharge and enhanced recovery. We believe that this focus on long-term reductions in pain and persistent opioid use will allow for these patients to achieve all the benefits of undergoing weight loss surgery.…”

Section: Postoperative Pain Controlmentioning

confidence: 99%

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Perioperative Pain Management in Bariatric Anesthesia

Eipe

Budiansky

2022

Saudi J Anaesth

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Weight loss (bariatric) surgery is the most commonly performed elective surgical procedure in patients with morbid obesity. In this review, we provide an evidence-based update on perioperative pain management in bariatric anesthesia. We mention some newer preoperative aspects—medical optimization, physical preparation, patient education, and psychosocial factors—that can all improve pain management. In the intraoperative period, with bariatric surgery being almost universally performed laparoscopically, we emphasize the use of non-opioid adjuvant infusions (ketamine, lidocaine, and dexmedetomidine) and suggest some novel regional anesthesia techniques to reduce pain, opioid requirements, and side effects. We discuss some postoperative strategies that additionally focus on patient safety and identify patients at risk of persistent pain and opioid use after bariatric surgery. This review suggests that the use of a structured, step-wise, severity-based, opioid-sparing multimodal analgesic protocol within an enhanced recovery after surgery (ERAS) framework can improve postoperative pain management. Overall, by incorporating all these aspects throughout the perioperative journey ensures improved patient safety and outcomes from pain management in bariatric anesthesia.

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Section: Preoperative Preparationmentioning

confidence: 99%

Section: Postoperative Pain Controlmentioning

confidence: 99%

Perioperative Pain Management in Bariatric Anesthesia

Eipe

Budiansky

2022

Saudi J Anaesth

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“…thus reducing nociceptive sensation and producing additive and synergistic analgesic effects. This is conducive to promoting functional exercise in the early postoperative period as well as in reducing the dosage of opioids used, nausea and vomiting, respiratory depression and other adverse effects 24–28. However, few studies have investigated the use of oxycodone combined with paravertebral nerve block for postoperative analgesia in lung cancer surgery, and objective data on the effects and doses of oxycodone in multimodal analgesic regimens for postoperative lung cancer are lacking.…”

Section: Introductionmentioning

confidence: 99%

Effect of oxycodone combined with ultrasound-guided thoracic paravertebral nerve block on postoperative analgesia in patients with lung cancer undergoing thoracoscopic surgery: protocol for a randomised controlled study

Wang,

Wu,

Liu

et al. 2023

BMJ Open

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IntroductionPostoperative pain is a main component influencing the recovery of patients with lung cancer. The combination of patient-controlled intravenous analgesia (PCIA) and paravertebral nerve block for postoperative analgesia in patients undergoing thoracoscopic lobectomy for lung cancer can achieve a satisfactory analgesic effect and promote early rehabilitation of patients. The objective is to investigate the optimal dose of oxycodone for PCIA combined with paravertebral nerve block, to achieve effective multimodal analgesia management in patients undergoing thoracoscopic lung cancer lobectomy.Methods and analysisThis prospective, double-blind, single-centre, parallel-group, superiority study from 7 April 2023 to 31 December 2024 will include 160 participants scheduled for thoracoscopic lobectomy for lung cancer. Participants will be randomly assigned to four groups in a 1:1:1:1 ratio: OCA group (oxycodone: 0.5 mg/kg), OCB group (oxycodone: 1.0 mg/kg), OCC group (oxycodone: 1.5 mg/kg) and one sufentanil group (sufentanil: 2 µg/kg). Flurbiprofen 50 mg and ondansetron 16 mg are added to each group. All the drugs are diluted with 0.9% saline in a 100 mL volume, with a background infusion rate of 2 mL/hour, a bolus dose of 0.5 mL and a lockout interval of 15 min. The primary outcome is pain scores at rest and dynamic at 24 hours after surgery using a Numeric Rating Scale (NRS). Dynamic NRS scores are defined as NRS when coughing. NRS scores will be assessed at 2, 4, 12, 24 and 48 hours postoperatively. The secondary outcomes include the following variables: (1) NRS score at rest and dynamic at 2, 4, 12 and 48 hours postoperatively; (2) total dose of sufentanil or oxycodone consumption in PCIA; (3) the times of patient-controlled analgesia; (4) Ramsay Sedation Score (RSS) at 2, 4, 12, 24 and 48 hours after the surgery; (5) extubation time; (6) serum C-reactive protein and interleukin six levels; (7) incidence of postoperative nausea and vomiting; (8) incidence of itching; (9) incidence of respiratory depression and (10) gastrointestinal recovery (exhaust time).Ethics and disseminationThe First Affiliated Hospital of Shandong First Medical University’s Ethics Committee granted consent for this study (approval number: YXLL-KY-2022(116)). To enable widespread use of the data gathered, we plan to publish the trial’s findings in an appropriate scientific journal after it is complete.Trial registration numberNCT05742256.

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“…Patients with obesity using prescription opioids preoperatively are more likely to continue these drugs after bariatric surgery than opioid-naïve patients, which is not without risks [ 18 , 19 , 20 , 21 , 22 ]. The perioperative use of opioids in bariatric surgery results in worsened clinical outcomes (e.g., a more extended hospital stay and increased episodes of apnea) and in particular persistent opioid use post-discharge [ 17 , 23 , 24 , 25 , 26 ].…”

Section: Introductionmentioning

confidence: 99%

Opioid Analgesics after Bariatric Surgery: A Scoping Review to Evaluate Physiological Risk Factors for Opioid-Related Harm

Wuyts

Torensma

Schellekens

et al. 2023

JCM

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The persisting use of opioids following bariatric surgery has emerged as a prevalent complication, heightening the probability of opioid-related harm (ORM), such as opioid-related fatalities and prescription opioid use disorder (OUD). A comprehensive review of PubMed literature from 1990 to 2023 was conducted to pinpoint physiological influences on postoperative ORM. As a result, we found that patients undertaking bariatric operations often exhibit an inherently higher risk for substance use disorders, likely attributable to genetic predisposition and related neurobiological changes that engender obesity and addiction-like tendencies. Furthermore, chronic pain is a common post-bariatric surgery complaint, and the surgical type impacts opioid needs, with increased long-term opioid use after surgeries. Additionally, the subjective nature of pain perception in patients with obesity can distort pain reporting and the corresponding opioid prescription both before and after surgery. Furthermore, the postoperative alterations to the gastrointestinal structure can affect the microbiome and opioid absorption rates, resulting in fluctuating systemic exposure to orally ingested opioids. The prospect of ORM development post-bariatric surgery appears amplified due to a preexisting susceptibility to addictive habits, surgically induced pain, modified gut–brain interaction and pain management and the changed pharmacokinetics post-surgery. Further research is warranted to clarify these potential risk variables for ORM, specifically OUD, in the bariatric population.

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Hospital opioid use predicts the need for discharge opioid prescriptions following laparoscopic bariatric surgery

Cited by 9 publications

References 19 publications

Perioperative Pain Management in Bariatric Anesthesia

Perioperative Pain Management in Bariatric Anesthesia

Effect of oxycodone combined with ultrasound-guided thoracic paravertebral nerve block on postoperative analgesia in patients with lung cancer undergoing thoracoscopic surgery: protocol for a randomised controlled study

Opioid Analgesics after Bariatric Surgery: A Scoping Review to Evaluate Physiological Risk Factors for Opioid-Related Harm

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