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A Review of Opioid-Sparing Modalities in Perioperative Pain Management: Methods to Decrease Opioid Use Postoperatively

Kumar, Kanupriya MD*; Kirksey, Meghan A. MD, PhD*; Duong, Silvia BScPharm, PharmD; Wu, Christopher L. MD

doi: 10.1213/ANE.0000000000002497
Chronic Pain Medicine: Narrative Review Article

There is an epidemic of opioid use, abuse, and misuse in the United States, which results in significant morbidity and mortality. It may be difficult to reduce perioperative opioid use given known acute surgical trauma and resultant pain; however, the discrete and often limited nature of postoperative pain also may make management easier in part by utilizing nonopioid modalities, such as regional anesthesia/analgesia, and multimodal analgesia, which may decrease the need for powerful opioids. This article reviews the relevant literature describing the use of adjunct medications, regional anesthesia and analgesic techniques, and regional block additives in the context of providing adequate pain control while lessening opioid use.

From the *Department of Anesthesiology, Hospital for Special Surgery, New York; Herzl Family Medicine Centre, Jewish General Hospital, McGill University, Montreal, Quebec, Canada; and Department of Anesthesiology and Critical Care Medicine, the Johns Hopkins Hospital, Baltimore, Maryland.

Accepted for publication August 18, 2017.

Funding: None.

The authors declare no conflicts of interest.

Reprints will not be available from the authors.

Address correspondence to Kanupriya Kumar, MD, Department of Anesthesiology, Hospital for Special Surgery, 535 E 70th St, New York, NY 10021. Address e-mail to

© 2017 International Anesthesia Research Society
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