Articles: opioid.
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Reg Anesth Pain Med · Oct 2021
ReviewBuprenorphine management in the perioperative period: educational review and recommendations from a multisociety expert panel.
The past two decades have witnessed an epidemic of opioid use disorder (OUD) in the USA, resulting in catastrophic loss of life secondary to opioid overdoses. Medication treatment of opioid use disorder (MOUD) is effective, yet barriers to care continue to result in a large proportion of untreated individuals. Optimal analgesia can be obtained in patients with MOUD within the perioperative period. Anesthesiologists and pain physicians can recommend and consider initiating MOUD in patients with suspected OUD at the point of care; this can serve as a bridge to comprehensive treatment and ultimately save lives. ⋯ To decrease the risk of OUD recurrence, buprenorphine should not be routinely discontinued in the perioperative setting. Buprenorphine can be initiated in untreated patients with OUD and acute pain in the perioperative setting to decrease the risk of opioid recurrence and death from overdose.
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The failure of past practices and policies related to opioid prescribing for chronic pain has led federal agencies and professional organizations to recommend multimodal approaches that prioritize evidence-based nonpharmacological pain treatments (NPTs). These multimodal approaches, which include both traditional and complementary/integrative approaches, hold great promise for reducing the burden of chronic pain and reducing opioid use. ⋯ Despite these dual crises of chronic pain and opioid use in the U. S., there has never been a concerted effort to broadly educate the American public about these issues and NPT pain management options.
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J Subst Abuse Treat · Oct 2021
ReviewHow emergency department visits for substance use disorders have evolved during the early COVID-19 pandemic.
Higher opioid overdoses and drug use have reportedly occurred during the COVID-19 pandemic. We provide evidence on how emergency department (ED) visits for substance use disorders (SUD) changed in the early pandemic period. ⋯ The 2020/2019 ratios of SUD ED visits fell substantially early in the COVID-19 pandemic, yet less than non-SUD, non-COVID ED visits. SUD ED visit ratios partly or fully recovered to 2019 levels by early June 2020, but did not exceed early 2020 ratios.
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Reg Anesth Pain Med · Oct 2021
ReviewPsychological interventions to reduce postoperative pain and opioid consumption: a narrative review of literature.
Evidence suggests that over half of patients undergoing surgical procedures suffer from poorly controlled postoperative pain. In the context of an opioid epidemic, novel strategies for ameliorating postoperative pain and reducing opioid consumption are essential. Psychological interventions defined as strategies targeted towards reducing stress, anxiety, negative emotions and depression via education, therapy, behavioral modification and relaxation techniques are an emerging approach towards these endpoints. ⋯ Some preoperative psychological interventions can reduce pain scores and opioid consumption in the acute postoperative period; however, there is a clear need to strengthen the evidence for these interventions. The optimal technique, strategies, timing and interface requires further investigation.
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Meta Analysis
Comparison between remifentanil and other opioids in adult critically ill patients: A systematic review and meta-analysis.
To identify the efficacy and safety of remifentanil when compared with other opioids in adult critically ill patients. ⋯ CRD42016041438.