The entire field of medicine, not just anesthesiology, has grown comfortable with the risks posed by opioids; but these risks are unacceptably high. It is time for a dramatic paradigm shift. If used at all for acute or chronic pain management, they should be used only after consideration and maximizing the use of nonopioid pharmacologic agents, regional analgesia techniques, and nonpharmacologic methods. Opioids poorly control pain, their intraoperative use may increase the risk of recurrence of some types of cancer, and they have a large number of both minor and serious side effects. Furthermore, there are a myriad of alternative analgesic strategies that provide superior analgesia, decrease recovery time, and have fewer side effects and risks associated with their use. In this article the negative consequences of opioid use for pain, appropriate alternatives to opioids for analgesia, and the available evidence in pediatric populations for both are described.
Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Lucile Packard Children’s Hospital Stanford, Stanford, CA
Support was provided solely from institutional and/or departmental sources of the Massachusetts General Hospital Department of Anesthesia, Critical Care and Pain Medicine, Boston, MA and the Stanford University Medical School Department of Anesthesiology, Perioperative and Pain Medicine, Stanford, CA. The author declares no conflict of interest.
Reprints: Thomas A. Anderson, MD, PhD, 300 Pasteur Drive, MC5640, Stanford, CA 94305 (e-mail: firstname.lastname@example.org).
Received January 17, 2019
Received in revised form February 10, 2019
Accepted January 17, 2019