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Chronic Opioid Use After Surgery: Implications for Perioperative Management in the Face of the Opioid Epidemic

Hah, Jennifer M. MD, MS*; Bateman, Brian T. MD, MSc; Ratliff, John MD‡§; Curtin, Catherine MD; Sun, Eric MD, PhD¶#

doi: 10.1213/ANE.0000000000002458
Chronic Pain Medicine: Narrative Review Article
Continuing Medical Education

Physicians, policymakers, and researchers are increasingly focused on finding ways to decrease opioid use and overdose in the United States both of which have sharply increased over the past decade. While many efforts are focused on the management of chronic pain, the use of opioids in surgical patients presents a particularly challenging problem requiring clinicians to balance 2 competing interests: managing acute pain in the immediate postoperative period and minimizing the risks of persistent opioid use after the surgery. Finding ways to minimize this risk is particularly salient in light of a growing literature suggesting that postsurgical patients are at increased risk for chronic opioid use. The perioperative care team, including surgeons and anesthesiologists, is poised to develop clinical- and systems-based interventions aimed at providing pain relief in the immediate postoperative period while also reducing the risks of opioid use longer term. In this paper, we discuss the consequences of chronic opioid use after surgery and present an analysis of the extent to which surgery has been associated with chronic opioid use. We follow with a discussion of the risk factors that are associated with chronic opioid use after surgery and proceed with an analysis of the extent to which opioid-sparing perioperative interventions (eg, nerve blockade) have been shown to reduce the risk of chronic opioid use after surgery. We then conclude with a discussion of future research directions.

From the *Division of Pain Medicine, Department of Anesthesiology, Perioperative, and Pain Medicine, Stanford University, Stanford, California; Department of Anesthesiology, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts; and Department of Neurosurgery, §Department of Orthopaedic Surgery (by courtesy), Division of Hand and Plastic Surgery, Department of Orthopaedic Surgery, Department of Anesthesiology, Perioperative, and Pain Medicine, and #Department of Health Research and Policy (by courtesy), Stanford University, Stanford, California.

Accepted for publication August 2, 2017.

Funding: J.M.H. was supported by K23DA035302 from the National Institute on Drug Abuse. B.T.B. was supported by the Eunice Kennedy Shriver National Institute of Child Health and Human Development of the National Institutes of Health (Bethesda, MD) under Award Number K08HD075831.

Conflicts of Interest: See Disclosures at the end of the article.

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Address correspondence to Jennifer M. Hah, MD, MS, Division of Pain Medicine, Department of Anesthesiology, Perioperative, and Pain Medicine, Stanford University, 1070 Arastradero Rd, Suite 200, Palo Alto, CA 94304. Address e-mail to jhah@stanford.edu.

© 2017 International Anesthesia Research Society
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