Investigating Opioid-Free Analgesia—Practice Makes Perfect

Abstract

As the medical community continues to highlight the many causes and consequences of the present opioid crisis in North America, opioid-free perioperative analgesia has emerged as one potential strategy to mitigate a key factor associated with chronic opioid use. It was with interest, then, that I reviewed the article by Do and colleagues, 1 written on behalf of the McGill Better Opioid Prescribing Collaboration. The authors detailed the results of an assessor-blinded, pragmatic pilot randomized clinical trial investigating the feasibility of conducting a full comparative effectiveness trial of prescribing postoperative opioid analgesia compared with opioid-free analgesia among patients undergoing outpatient general surgery. In both trial arms (opioid: 39 participants; opioid-free: 37 participants), patients received protocolized around-the-clock nonopioids as first-line therapy, with patients in the opioid analgesia group receiving opioids in the event of breakthrough pain. The trial achieved its primary objective, a strict set of a priori feasibility outcomes that, aside from the traditional eligibility and follow-up criteria, established thresholds for agreement to participate on the part of patients and surgeons and for treatment adherence. Although not the basis for the trial, the researchers also reported a number of secondary clinical outcomes, including similar findings between groups for self-reported pain and satisfaction scores and preliminary data for opioid-related adverse events. The trial's feasibility, coupled with the extensive number of assessments, may serve as a framework for future, large-scale investigation.

Regional block techniques for pain management after video-assisted thoracoscopic surgery: a covariate-adjusted Bayesian network meta-analysis

“…Opioid-free or low-opioid analgesia after surgery has become an important perioperative issue [ 71 , 72 ]. Through the comparison of opioid and non-opioid analgesia after discharge from the hospital, we can find that opioid-free analgesia leads to numerous favorable prognostic events for patients [ 73 , 74 ].…”