System-level policies on appropriate opioid use, a multi-stakeholder consensus

Forget, Patrice; Patullo, Champika; Hill, Duncan; Ambekar, Atul; Baldacchino, Alex; Cata, Juan P.; Chetty, Sean; Cox, Felicia; Boer, Hans D. de; Dinwoodie, Kieran; Dom, Geert; Eccleston, Christopher; Fullen, Brona M.; Jutila, Liisa; Knaggs, Roger; Lavand’homme, Patricia; Levy, N.; Lobo, Dileep N.; Pogatzki-Zahn, Esther; Scherbaum, Norbert; Smith, Blair H.; Griensven, Joop van; Gilbert, Steve

doi:10.1186/s12913-022-07696-x

Cited by 13 publications

(28 citation statements)

References 35 publications

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“…The Delphi method is a well-known process used for obtaining group consensus in healthcare, as it encourages decision making and new ideas to be formed by whole group feedback [ 15 , 16 ]. The method involves several rounds of anonymous questionnaires, where after each round structured feedback and aggregated responses from previous rounds are presented to panellists ( Figure 1 ).…”

Section: Methodsmentioning

confidence: 99%

Expert Multinational Consensus Statement for Total Intravenous Anaesthesia (TIVA) Using the Delphi Method

Uitenbosch

Sng

Carvalho

et al. 2022

JCM

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Introduction: The use of total intravenous anaesthesia (TIVA) has been well established as an anaesthetic technique over the last few decades. Significant variation in practice exists however, and volatile agents are still commonly used. This study aims to determine the motivations and barriers for using TIVA over the use of volatile agents by analysing the opinion of several international anaesthetists with specific expertise or interests. Methods and participants: The Delphi method was used to gain the opinions of expert panellists with a range of anaesthetic subspecialty expertise. Twenty-nine panellists were invited to complete three survey rounds containing statements regarding the use of TIVA. Anonymised data were captured through the software REDCap and analysed for consensus and prioritisation across statements. Starting with 12 statements, strong consensus was defined as ≥75% agreement. Stability was assessed between rounds. Results: Strong consensus was achieved for four statements regarding considerations for the use of TIVA. These statements addressed whether TIVA is useful in paediatric anaesthesia, the importance of TIVA in reducing the incidence of postoperative nausea and vomiting, its positive impact on the environment and effect on patient physiology, such as airway and haemodynamic control. Conclusions: Using the Delphi method, this international consensus showed that cost, lack of familiarity or training and the risk of delayed emergence are not considered obstacles to TIVA use. It appears, instead, that the primary motivations for its adoption are the impact of TIVA on patient experience, especially in paediatrics, and the benefit to the overall procedure outcome. The effect of TIVA on postoperative nausea and vomiting and patient physiology, as well as improving its availability in paediatrics were considered as priorities. We also identified areas where the debate remains open, generating new research questions on geographical variation and the potential impact of local availability of monitoring equipment.

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Section: Methodsmentioning

confidence: 99%

Expert Multinational Consensus Statement for Total Intravenous Anaesthesia (TIVA) Using the Delphi Method

Uitenbosch

Sng

Carvalho

et al. 2022

JCM

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“…Over 50% of patients complain of moderate to severe pain despite medical treatment [30]. Reasons of mismanagement of cancer pain can be related to physicians (undertreatment due to fear of side effects, no patient education, underestimation of pain, poor communication between patients and doctors, or no application of pain control guidelines) and to patients (scarce adherence to treatment, fear of side effects, lack of communication between patients and doctors, or pain considered as "normal") [23,27,31,32].…”

Section: Treatment Of Cancer Painmentioning

confidence: 99%

Spinal Cord Stimulation to Treat Unresponsive Cancer Pain: A Possible Solution in Palliative Oncological Therapy

Paolini

Ferini²,

Bonosi

et al. 2022

Life

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(1) Background: Treatment of cancer-related pain is still challenging, and it can be managed by both medical and interventional therapies. Spinal Cord Stimulation (SCS) is a minimally invasive technique, and its use is rapidly increasing in the treatment of chronic pain. (2) Materials and Methods: Our study aims to perform a review of the pertinent literature about current evidences in cancer pain treatment by Spinal Cord Stimulation. Moreover, we created a database based on case reports or case series (18 studies) in the literature. We analyzed a clinical group of oncological patients affected by intractable pain undergoing SCS implantation, focusing on outcome. (3) Results: The analysis of the 18 included studies in our series has shown a reduction in painful symptoms in 48 out of 56 treated patients (87.51%); also 53 out of 56 patients (96.64%) have shown an improvement in their Quality of Life (QoL). (4) Conclusions: Spinal Cord Stimulation can be considered an efficient method in the treatment of cancer-related pain. However, literature regarding SCS for the treatment of cancer-related pain is largely represented by case reports and small case series, with no effective population studies or Randomized Controlled Trials demonstrating the efficacy and the level of evidence. Further prospective studies are needed.

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“…Liberal prescribing of opioids for postoperative pain relief increases the risk of persistent postoperative opioid use and adverse outcomes, which has reached epidemic proportions in certain countries, especially in the USA (Jalal et al, 2018). These adverse outcomes include dependence, addiction, opioid use disorders, opioid-induced ventilatory impairment and overdose-related deaths (Forget et al, 2022). A study by Gomes et al (2018) assessed the burden of opioid-related deaths in the USA and found that the percentage of all deaths attributable to opioids increased by an alarming 292% (from 0.4-1.5%) between 2001 and 2016.…”

Section: Introductionmentioning

confidence: 99%

Opioid Prescribing for Acute Postoperative Pain: An Overview of Systematic Reviews

McCorquodale,

Greening,

Tulloch

et al. 2023

Preprint

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Background National guidelines for rational opioid prescribing for acute postoperative pain are needed to optimise postoperative pain control and function whilst minimising opioid-related harm. Objectives This overview of systematic reviews aims to summarise and critically assess the quality of systematic reviews related to the 20 previously published recommendations (ten relevant at patient and prescriber levels and ten at a system / Public Health level). It also aims to identify gaps in research that require further efforts to fill these in order to augment the evidence behind creating national guidelines for rational opioid prescribing for acute postoperative pain. Methods A systematic database search using PubMed/MEDLINE and Cochrane was conducted in November 2022. Furthermore, reference lists were reviewed. All identified systematic reviews were assessed for eligibility. Data from each study was extracted using a pre-standardised data extraction form. The methodological quality of the included reviews was assessed by two independent reviewers using the AMSTAR 2 checklist. Descriptive synthesis of the results was performed. Results A total of 12 papers were eligible for analysis. Only eight out of the total 20 prioritised recommendations had systematic reviews that provided evidence related to them. These systematic reviews were most commonly of critically low quality. Conclusion The consensus papers provide guidance and recommendations based on the consensus of expert opinion that is based on the best available evidence. However, there is a lack of evidence supporting many of these consensus statements. Efforts to further analyse interventions that aim to reduce the rates of opioid prescribing and their adverse effects should therefore continue.

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System-level policies on appropriate opioid use, a multi-stakeholder consensus

Cited by 13 publications

References 35 publications

Expert Multinational Consensus Statement for Total Intravenous Anaesthesia (TIVA) Using the Delphi Method

Expert Multinational Consensus Statement for Total Intravenous Anaesthesia (TIVA) Using the Delphi Method

Spinal Cord Stimulation to Treat Unresponsive Cancer Pain: A Possible Solution in Palliative Oncological Therapy

Opioid Prescribing for Acute Postoperative Pain: An Overview of Systematic Reviews

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