Reducing Opioid Prescribing and Consumption After Surgery—Keeping the Lock on Pandora’s Box

McCoul, Edward D.; Barnett, Michael L.; Brenner, Michael

doi:10.1001/jamaoto.2021.1846

Cited by 4 publications

(4 citation statements)

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“…Ineffective postoperative pain management may cause immunosuppression, infections, and less effective wound healing ( 75 ). For most people, their first exposure to opioids was during surgeries ( 76 ). Regional anesthetic techniques may play a role in decreasing or sparing opioid exposure when opioid dependence, opioid overdose, and community overuse and misuse are becoming incisive social issues.…”

Section: Discussionmentioning

confidence: 99%

Comparison of regional anesthetic techniques for postoperative analgesia after adult cardiac surgery: bayesian network meta-analysis

Zhou

Song

2023

Front. Cardiovasc. Med.

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BackgroundPatients usually suffer acute pain after cardiac surgery. Numerous regional anesthetic techniques have been used for those patients under general anesthesia. The most effective regional anesthetic technique was still unclear.MethodsFive databases were searched, including PubMed, MEDLINE, Embase, ClinicalTrials.gov, and Cochrane Library. The efficiency outcomes were pain scores, cumulative morphine consumption, and the need for rescue analgesia in this Bayesian analysis. Postoperative nausea, vomiting and pruritus were safety outcomes. Functional outcomes included the time to tracheal extubation, ICU stay, hospital stay, and mortality.ResultsThis meta-analysis included 65 randomized controlled trials involving 5,013 patients. Eight regional anesthetic techniques were involved, including thoracic epidural analgesia (TEA), erector spinae plane block, and transversus thoracic muscle plane block. Compared to controls (who have not received regional anesthetic techniques), TEA reduced the pain scores at 6, 12, 24 and 48 h both at rest and cough, decreased the rate of need for rescue analgesia (OR = 0.10, 95% CI: 0.016–0.55), shortened the time to tracheal extubation (MD = −181.55, 95% CI: −243.05 to −121.33) and the duration of hospital stay (MD = −0.73, 95% CI: −1.22 to −0.24). Erector spinae plane block reduced the pain score 6 h at rest and the risk of pruritus, shortened the duration of ICU stay compared to controls. Transversus thoracic muscle plane block reduced the pain scores 6 and 12 h at rest compared to controls. The cumulative morphine consumption of each technique was similar at 24, 48 h. Other outcomes were also similar among these regional anesthetic techniques.ConclusionsTEA seems the most effective regional postoperative anesthesia for patients after cardiac surgery by reducing the pain scores and decreasing the rate of need for rescue analgesia.Systematic Review Registrationhttps://www.crd.york.ac.uk/prospero/, ID: CRD42021276645

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Section: Discussionmentioning

confidence: 99%

Comparison of regional anesthetic techniques for postoperative analgesia after adult cardiac surgery: bayesian network meta-analysis

Zhou

Song

2023

Front. Cardiovasc. Med.

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“…In a first effort to regain control (and more effectively prevent iatrogenic addiction), doctors and pharmacists, supported by regulatory authorities, could develop appropriate training programs and safe-guarding professional independence [166]. This may also help to prevent a new era of opiophobia and a painful underprescription of opioids.…”

Section: Discussionmentioning

confidence: 99%

The Imperative of Regulation: The Co-Creation of a Medical and Non-Medical US Opioid Crisis

Pieters

2023

Psychoactives

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The ravaging COVID-19 pandemic has almost pushed into oblivion the fact that the United States is still struggling with an immense addiction crisis. Drug overdose deaths rose from 16,849 in 1999 to nearly 110,000—of which an estimated 75,000 involved opioids—in 2022. On a yearly basis, the opioid casualty rate is higher than the combined number of victims of firearm violence and car accidents. The COVID-19 epidemic might have helped to worsen the addiction crisis by stimulating drug use among adolescents and diverting national attention to yet another public health crisis. In the past decade, the sharpest increase in deaths occurred among those related to fentanyl and fentanyl analogs (illicitly manufactured, synthetic opioids of greater potency). In the first opioid crisis wave (1998–2010), opioid-related deaths were mainly associated with prescription opioids such as Oxycontin (oxycodone hydrochloride). The mass prescription of these narcotic drugs did anything but control the pervasive phenomenon of ‘addiction on prescription’ that played such an important role in the emergence and robustness of the US opioid crisis. Using a long-term drug lifecycle analytic approach, in this article I will show how opioid-producing pharmaceutical companies created a medical market for opioid painkillers. They thus fueled a consumer demand for potent opioid drugs that was eagerly capitalized on by criminal entrepreneurs and their international logistic networks. I will also point out the failure of US authorities to effectively respond to this crisis due to the gap between narcotic product regulation, regulation of marketing practices and the rise of a corporate-dominated health care system. Ironically, this turned the most powerful geopolitical force in the war against drugs into its greatest victim. Due to formulary availability and regulatory barriers to accessibility, European countries have been relatively protected against following suit the US opioid crisis.

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“…In contrast, the risks of SCS are far greater 1 . Similar to a growing awareness of the need for opioid 19–22 and antibiotic 23–26 stewardship in otolaryngology, there is a vital role for SCS stewardship. The conscientious clinician may ask, “When do the benefits of SCS outweigh the risks, and what is the evidence?” In this state of the art review, we shine a light on this question, curating the literature to guide otolaryngology practice.…”

Section: Adverse Effects Organ System Short Term Long Termmentioning

confidence: 99%

“…17,18 In contrast, the risks of SCS are far greater. 1 Similar to a growing awareness of the need for opioid [19][20][21][22] and antibiotic [23][24][25][26] stewardship in otolaryngology, there is a vital role for SCS stewardship. The conscientious clinician may ask, ''When do the benefits of SCS outweigh the risks, and what is the evidence?''…”

mentioning

confidence: 99%

Systemic Steroids for Otolaryngology–Head and Neck Surgery Disorders: An Evidence‐Based Primer for Clinicians

McCoul

Megwalu

Joe

et al. 2022

Otolaryngol.--head neck surg.

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Objective To offer pragmatic, evidence-informed guidance on the use of systemic corticosteroids (SCS) for common otolaryngologic disorders. Data Sources PubMed, Cochrane Library, and American Academy of Otolaryngology–Head and Neck Surgery Foundation clinical practice guidelines. Review Methods A comprehensive search of published literature through November 2021 was conducted on the efficacy of SCS, alone or in combination with other treatments, for managing disorders in otolaryngology and the subdisciplines. Clinical practice guidelines, systematic reviews, and randomized controlled trials, when available, were preferentially retrieved. Interventions and outcomes of SCS use were compiled to generate summary tables and narrative synthesis of findings. Conclusions Evidence on the effectiveness of SCS varies widely across otolaryngology disorders. High-level evidence supports SCS use for Bell’s palsy, sinonasal polyposis, and lower airway disease. Conversely, evidence is weak or absent for upper respiratory tract infection, eustachian tube dysfunction, benign paroxysmal positional vertigo, adenotonsillar hypertrophy, or nonallergic rhinitis. Evidence is indeterminate for acute laryngitis, acute pharyngitis, acute sinusitis, angioedema, chronic rhinosinusitis without polyps, Ménière’s disease, postviral olfactory loss, postoperative nerve paresis/paralysis, facial pain, and sudden sensorineural hearing loss. Implications for Practice Clinicians should bring an evidence-informed lens to SCS prescribing to best counsel patients regarding the risks, anticipated benefits, and limited data on long-term effects. Alternate routes of corticosteroid administration—such as sprays, drops, inhalers, and intralesional injections—may be preferable for many disorders, particularly those that are self-limited or require a prolonged duration of therapy. Prudent use of SCS reduces the risk of medication-related adverse effects. Clinicians who are conversant with high-level evidence can achieve optimal outcomes and stewardship when prescribing SCS.

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Reducing Opioid Prescribing and Consumption After Surgery—Keeping the Lock on Pandora’s Box

Abstract: 70238-X 20. Gallagher EJ, Liebman M, Bijur PE. Prospective validation of clinically important changes in pain severity measured on a visual analog scale.

Cited by 4 publications

References 7 publications

Comparison of regional anesthetic techniques for postoperative analgesia after adult cardiac surgery: bayesian network meta-analysis

Comparison of regional anesthetic techniques for postoperative analgesia after adult cardiac surgery: bayesian network meta-analysis

The Imperative of Regulation: The Co-Creation of a Medical and Non-Medical US Opioid Crisis

Systemic Steroids for Otolaryngology–Head and Neck Surgery Disorders: An Evidence‐Based Primer for Clinicians

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