Reducing Opioid Overprescribing through Procedure-specific Prescribing Guidelines

Zhang, Kevin K.; Blum, Kevin M.; Chu, Jacqueline J.; Sharma, Shuchi; Skoracki, Roman J.; Moore, Amy M.; Janis, Jeffrey E.; Barker, Jenny C.

doi:10.1097/gox.0000000000004776

Cited by 1 publication

(1 citation statement)

References 31 publications

(52 reference statements)

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“…2 This can delay ambulation and rehabilitation, which can delay recovery after surgery. 1 Although multimodal analgesia strategy has been recommended, [3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18] it is inappropriately applied, 19 and opioids are often administered to alleviate postoperative pain. 20 However, as a response to the opioid crisis, there has been a paradigm shift toward an opioid-averse approach to pain management, emphasizing the need for nonopioid alternatives.…”

Section: Introductionmentioning

confidence: 99%

Use of Muscle Relaxants for Acute Postoperative Pain: A Practical Review

Farishta,

Iancau,

Janis

et al. 2024

Plastic and Reconstructive Surgery - Global Open

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Background: Skeletal muscle relaxants have emerged as a broad category of analgesic adjuncts, aiming to improve pain relief and reduce opioid reliance. These drugs induce muscle relaxation and reduce muscle spasms, and therefore, they are commonly used in surgical procedures involving muscle manipulation, such as abdominal surgery, breast surgery, and spine surgery. However, their analgesic efficacy and opioid-sparing effects are poorly explored. Methods: A scoping review of literature was performed with several electronic databases. We used a search string with a sequence of text words and word variants related to central muscle relaxants, pain management, postoperative pain, and specific muscle relaxants. Results: Review of literature shows significant heterogeneity among the studies in terms of surgical procedures, patient populations, choice of muscle relaxant, and timing and duration of administration, potentially limiting the generalizability of the findings and the ability for pooled analysis. Conclusions: Given the lack of evidence, we recommend that the use of skeletal muscle relaxants be reserved for patients in whom an optimal multimodal analgesic technique is not adequate. Also, there may be a limited role for these drugs in patients at high risk of postoperative pain undergoing surgical procedures with expected high opioid requirements. Due to the concerns of potential adverse effects, the decision to use muscle relaxants in vulnerable populations should be made carefully, weighing the benefits against the risks.

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