Prolonged Opioid Use After Knee Arthroscopy in Military Veterans

Rozet, Irene; Nishio, Isuta; Robbertze, Reinette; Rotter, Douglas; Chansky, Howard A.; Hernandez, Adrián V.

doi:10.1213/ane.0000000000000292

Cited by 65 publications

(36 citation statements)

References 21 publications

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“…VR distraction has no known long-lasting side effects, unlike opioids, and limiting opioid exposure may affect patients' development of opioid-induced hyperalgesia in the perioperative period [12]. Given the prevalence of long-term opioid use after even low-risk surgery [1314], anesthesiologists need to explore non-opioid analgesic modalities to maximize patient comfort and safety.…”

Section: Discussionmentioning

confidence: 99%

Virtual reality distraction decreases routine intravenous sedation and procedure-related pain during preoperative adductor canal catheter insertion: a retrospective study

Pandya

Kim

Howard

et al. 2017

Korean J Anesthesiol

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BackgroundVirtual reality (VR) distraction is a nonpharmacological method to prevent acute pain that has not yet been thoroughly explored for anesthesiology. We present our experience using VR distraction to decrease routine intravenous sedation for patients undergoing preoperative perineural catheter insertion.MethodsThis 1-month quality improvement project involved all elective unilateral primary total knee arthroplasty patients who received a preoperative adductor canal catheter. Clinical data were analyzed retrospectively. For the first half of the month, all patients received usual care; intravenous sedation was administered at the discretion of the regional anesthesiologist. For the second half of the month, patients were offered VR distraction with intravenous sedation upon request. The primary outcome was fentanyl dosage; other outcomes included midazolam dosage, procedure-related pain, procedural time, and blood pressure changes.ResultsSeven patients received usual care and seven used VR. In the VR group, 1/7 received intravenous sedation versus 6/7 who received usual care (P = 0.029). The fentanyl dose was lower (median [10th–90th percentiles]) in the VR group (0 [0–20] µg) versus the non-VR group (50 [30–100] µg; P = 0.008). Midazolam use was lower in the VR group (0 [0–0] mg) than in the non-VR group (1 [0–1] mg; P = 0.024). Procedure-related pain was lower in the VR group (1 [1–4] NRS) versus the non-VR group (3 [2–6] NRS; P = 0.032). There was no difference in other outcomes.ConclusionsVR distraction may provide an effective nonpharmacological alternative to intravenous sedation for the ultrasound-guided placement of certain perineural catheters.

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Section: Discussionmentioning

confidence: 99%

Virtual reality distraction decreases routine intravenous sedation and procedure-related pain during preoperative adductor canal catheter insertion: a retrospective study

Pandya

Kim

Howard

et al. 2017

Korean J Anesthesiol

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“…17 Among surgical patients, long-term postoperative opioid use was associated with younger age, lower household income, diabetes, heart failure, pulmonary disease, PTSD, preoperative pain, and preoperative opioid use. 18–20 In ambulatory care patients, longer-term opioid use was associated with a history of substance abuse, older age, being female, and depression 5, 6, 8 . More specifically, among disabled Medicare beneficiaries, long-term and intermittent opioid use was associated with female sex, increased likelihood of having musculoskeletal disease, and depression compared to patients not using opioids.…”

Section: Discussionmentioning

confidence: 99%

Incidence and Risk Factors for Progression From Short-term to Episodic or Long-term Opioid Prescribing

Hooten

Sauver

McGree

et al. 2015

Mayo Clinic Proceedings

114

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Objective-To determine what proportion of a geographically-defined population who receive new opioid prescriptions progress to episodic or chronic patterns of opioid prescribing, and to explore the clinical characteristics associated with patterns of opioid prescribing.Methods-Population-based drug prescription records for the Olmsted County population between January 1 and December 31, 2009 were obtained using the Rochester Epidemiology Project medical records linkage system (n=142,377). All medical records were reviewed for a random sample of 293 patients who had a new ("incident") prescription for an opioid analgesic in 2009. Patients were followed through their medical records for 1 year following their initial prescription date, with patterns of opioid prescribing categorized as acute, episodic, or chronic.

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“…The definitions of opioid therapy during the time windows within the follow-up time were not strict and many definitions only required one opioid prescription during a predefined time period for LTOT. 40,[43][44][45][46][47][48][49][50][51][52][53][54] For example, one study defined LTOT as at least one prescription 305 to 425 days after a hospital discharge. 44 By only requiring one prescription during a specified window of time after the index date, these definitions fail to identify consistent use.…”

Section: /1002 = 57%mentioning

confidence: 99%

Long‐term opioid therapy definitions and predictors: A systematic review

Karmali

Bush

Raman

et al. 2019

Pharmacoepidemiology and Drug

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Purpose This review sought to (a) describe definitions of long‐term opioid therapy (LTOT) outcome measures, and (b) identify the predictors associated with the transition from short‐term opioid use to LTOT for opioid‐naïve individuals. Methods We conducted a systematic review of the peer‐reviewed literature (January 2007 to July 2018). We included studies examining opioid use for more than 30 days. We classified operationalization of LTOT based on criteria used in the definitions. We extracted LTOT predictors from multivariate models in studies of opioid‐naïve individuals. Results The search retrieved 5,221 studies, and 34 studies were included. We extracted 41 unique variations of LTOT definitions. About 36% of definitions required a cumulative duration of opioid use of 3 months. Only 17% of definitions considered consecutive observation periods, 27% used days' supply, and no definitions considered dose. We extracted 76 unique predictors of LTOT from seven studies of opioid‐naïve patients. Common predictors included pre‐existing comorbidities (21.1%), non‐opioid prescription medication use (13.2%), substance use disorders (10.5%), and mental health disorders (10.5%). Conclusions Most LTOT definitions aligned with the chronic pain definition (pain more than 3 months), and used cumulative duration of opioid use as a criterion, although most did not account for consistent use. Definitions were varied and rarely accounted for prescription characteristics, such as days' supply. Predictors of LTOT were similar to known risk factors of opioid abuse, misuse, and overdose. As LTOT becomes a central component of quality improvement efforts, researchers should incorporate criteria to identify consistent opioid use to build the evidence for safe and appropriate use of prescription opioids.

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Prolonged Opioid Use After Knee Arthroscopy in Military Veterans

Cited by 65 publications

References 21 publications

Virtual reality distraction decreases routine intravenous sedation and procedure-related pain during preoperative adductor canal catheter insertion: a retrospective study

Virtual reality distraction decreases routine intravenous sedation and procedure-related pain during preoperative adductor canal catheter insertion: a retrospective study

Incidence and Risk Factors for Progression From Short-term to Episodic or Long-term Opioid Prescribing

Long‐term opioid therapy definitions and predictors: A systematic review

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