Virginia Anesthesia Services LLC Long-Term Opioid Use Related to Anesthesia  - Virginia Anesthesia Services LLC

Long-Term Opioid Use Related to Anesthesia 

The U.S. continues to face an opioid crisis, with the number of opioid deaths still on the rise. Long-term use of opioids following opioid-based anesthesia remains a significant challenge for many patients in this context. Persistent postoperative opioid use after cardiac surgery for example affects up to 1 in 20 patients 1, and approximately 40% of opioid overdose deaths involve a prescription opioid. The combined economic burden of prescription opioid-related overdose, abuse, and dependence generally exceeds $78.5 billion annually 2.  

With data showing incrementally increasing opioid prescription levels being linked to stepwise increases in complication risks 3, a number of professional entities have created guidelines to reduce opioid prescriptions 4

Entirely opioid-free anesthesia has also emerged as a more extreme option, with data showing a strong ability in some cases to reduce long-term opioid use and provide other benefits 5. Indeed, a recent systematic review and meta-analysis demonstrated that opioid-free anesthesia significantly reduced adverse postoperative events, mainly by virtue of decreased nausea and vomiting. In addition, postoperative opioid consumption was significantly lower in the opioid-free group. Meanwhile, there was no significant difference in length of post-anesthesia care unit stay and overall postoperative pain between groups, with the researchers concluding that opioid-free anesthesia improves postoperative outcomes across surgical settings, without incurring adverse effects on patient safety or pain management 6.  

However, opioid-free anesthesia still raises questions. First, accurate monitoring to measure intraoperative nociception and guide the use of adjuvants is not available. Second, there remains a need to develop procedure-specific strategies in addition to specific indications and contraindications for this approach. Finally, objective assessment of opioid-free anesthesia use on patient outcomes, including both long-term opioid use and pain management, needs to be recorded in the context of large multicenter studies 5

A recent narrative literature review sought to develop a comprehensive understanding of nociception and pain within the field of opioid-free anesthesia 7. Physiological, pharmacological, procedural (i.e. type of surgery), genetic and phenotypic factors were taken into consideration. Data revealed that vulnerable patients may benefit more from opioid-free anesthesia, with an interesting field of research pertaining to clinical patients suffering from vascular disease. Data also demonstrated that a variety of techniques and medications make it impossible to consider opioid-free anesthesia as a single technique.  

The researchers concluded that recent developments in opioid-free anesthesia may offer an entirely new more holistic approach, challenging the fundamental need for opioids and their associated risk of long-term opioid use. Meanwhile, a vast field of research remains to be explored. In particular, better understanding nociception, given the variety of opioid-free anesthesia techniques, may help maximize their potential in different contexts 7

Additional research remains to be carried out in order to elucidate the role of anesthesia in the context of long-term opioid use and the ways in which to best prevent the development of opioid use disorders following anesthesia regimens across clinical contexts. Crucial follow-up studies should be organized to shed light on the full extent of the impact of chronic opioid use on health worldwide, thereby providing tractable opportunities for intervention 4

References 

1. Liu, Z. et al. Epidemiology of persistent postoperative opioid use after cardiac surgery: a systematic review and meta-analysis. Br. J. Anaesth. 129, 366–377 (2022). doi: 10.1016/j.bja.2022.05.026. 

2. Burns, S., Urman, R., Pian, R. & Coppes, O. J. M. Reducing New Persistent Opioid Use After Surgery: A Review of Interventions. Curr. Pain Headache Rep. 25, (2021). doi: 10.1007/s11916-021-00943-6 

3. Cozowicz, C. et al. Opioid prescription levels and postoperative outcomes in orthopedic surgery. Pain (2017). doi:10.1097/j.pain.0000000000001047 

4. Poeran, J. & Memtsoudis, S. G. Chronic opioid use and long-term mortality: a global problem. British Journal of Anaesthesia (2020). doi:10.1016/j.bja.2019.09.033 

5. Lavand’homme, P. & Estebe, J. P. Opioid-free anesthesia: A different regard to anesthesia practice. Current Opinion in Anaesthesiology (2018). doi:10.1097/ACO.0000000000000632 

6. Olausson, A. et al. Total opioid-free general anaesthesia can improve postoperative outcomes after surgery, without evidence of adverse effects on patient safety and pain management: A systematic review and meta-analysis. Acta Anaesthesiologica Scandinavica (2022). doi:10.1111/aas.13994 

7. Goff, J. et al. Can Opioid-Free Anaesthesia Be Personalised? A Narrative Review. J. Pers. Med. 2023, Vol. 13, Page 500 13, 500 (2023). doi: 10.3390/jpm13030500.