Articles: analgesics.
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Many institutions have developed operation-specific guidelines for opioid prescribing. These guidelines rarely incorporate in-hospital opioid consumption, which is highly correlated with consumption. We compare outcomes of several patient-centered approaches to prescribing that are derived from in-hospital consumption, including several experimental, rule-based prescribing guidelines and our current institutional guideline. ⋯ Rather than relying on fixed quantities for defined operations, rule-based guidelines offer a simple yet effective method for tailoring opioid prescribing to in-hospital consumption.
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To determine whether the elimination of extended release (ER) opioids in the multimodal medication regimen of total knee replacement (TKR) patients resulted in improved patient outcomes. ⋯ Sixty patients were reviewed with a mean age at 70 years for both the pre-protocol (n = 36) and post-protocol groups (n = 34). There was a reduction in antiemetic use, t(59) = 2.2, p = .03 and length of stay, t(58) = 1.0, p = .33, and more discharges to home than rehab, x2 = 60, p < .001. All patients received 30 tablets of only one opioid prescription upon discharge with no refill, either oxycodone-IR (82%, n = 49), hydromorphone (5%, n = 3), or tramadol (12%, n = 7). The project, aimed to reduce opioid overprescription and overconsumption, has the potential to improve prescribing practices, promoting patient safety and healthcare quality by supporting the current guidelines that recommend against using ER opioids for the study population.
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J Coll Physicians Surg Pak · Jun 2024
Randomized Controlled TrialEffect of Dexmedetomidine Addition in Erector Spinae Plane Block on Opioid Consumption after Lumbar Spine Surgery.
To investigate the efficacy of adding 0.5 micrograms/kg of dexmedetomidine to 0.2% ropivacaine in erector spinae plane block in terms of 24-hour opioid consumption after lumbar spine surgeries. ⋯ Dexmedetomidine, Erector spinae plane block, Lumbar spine surgery, Opioid consumption, Pain control.
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The COVID-19 pandemic led to severe disruptions in health care and a relaxation of rules surrounding opioid prescribing-changes which led to concerns about increased reliance on opioids for chronic pain and a resurgence of opioid-related harms. Although some studies found that opioid prescriptions increased in the first 6 months of the pandemic, we know little about the longer-term effects of the pandemic on opioid prescriptions. Further, despite the prevalence of pain in veterans, we know little about patterns of opioid prescriptions in the Veterans Health Administration (VA) associated with the pandemic. ⋯ These findings suggest that the pandemic was not associated with short- or long-term increases in opioid prescriptions or doses in the VA. PERSPECTIVE: This article examines opioid prescribing over a 3-year period-1 year prior to and 2 years after the onset of the COVID-19 pandemic-for VA patients with chronic low-back pain. Results indicate that, despite disruptions to health care, opioid prescriptions and doses decreased over the entire observation period.
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Opioids are often prescribed for patients who eventually undergo lumbar decompression. Given the potential for opioid-related morbidity and mortality, postoperative weaning is often a goal of surgery. The purpose of this study was to examine the relationship between preoperative opioid use and postoperative complete opioid weaning among lumbar decompression patients. ⋯ Patients who used opioids for longer preoperatively were less likely to completely wean following surgery. Among patients with >180 days of preoperative use, those with lower preoperative doses were more likely to wean. Weaning was also associated with several clinical and demographic factors. These findings may help shape expectations regarding opioid use following lumbar decompression.