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Current Pain and Headache Reports

Erschienen in:

24.01.2022 | Regenerative Pain and Medicine/Interventional Pain and Medicine (EC Bradley, Section Editors)

Enhanced Recovery After Surgery: Opioid Sparing Strategies After Discharge: A Review

verfasst von: Kanishka Rajput, Sukhman Shergill, Robert M. Chow, Nalini Vadivelu, Alan David Kaye

Erschienen in: Current Pain and Headache Reports | Ausgabe 2/2022

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Abstract

Purpose of Review

Many surgical subspecialties have developed enhanced recovery after surgery (ERAS) protocols that focus on multimodal analgesia to limit opioid use during a hospital stay and improve patient recovery. Unfortunately, ERAS protocols do not extend to post-discharge patient care, and opioids continue to be over prescribed. The primary reason seems to be a lack of good quality research evaluating extended use of a multimodal analgesic approach. This review was undertaken to evaluate available evidence for non-opioid analgesics in the postoperative period after discharge, utilizing Pubmed, Scopus, and Google Scholar.

Recent Findings

Several studies have explored strategies to reduce the overprescribing of opioids after surgery without worsening postoperative pain scores or complications. However, these studies do not necessarily reflect on situations where an ultra-restrictive protocol may fail, leading to breakthrough pain. Ultra-restrictive opioid protocols, therefore, could risk undertreatment of acute pain and the development of persistent post-surgical pain, highlighting the need for a review of non-opioid strategies.

Summary

Our findings show that little research has been conducted on the efficacy of non-opioid therapies post-discharge including acetaminophen, NSAIDs, gabapentin, duloxetine, venlafaxine, tizanidine, valium, and oral ketamine. Further studies are warranted to more precisely evaluate the utility of these agents, specifically for their side effect profile and efficacy in improving pain-control and function while limiting opioid use.

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Titel: Enhanced Recovery After Surgery: Opioid Sparing Strategies After Discharge: A Review
verfasst von: Kanishka Rajput
Sukhman Shergill
Robert M. Chow
Nalini Vadivelu
Alan David Kaye
Publikationsdatum: 24.01.2022
Verlag: Springer US
Erschienen in: Current Pain and Headache Reports / Ausgabe 2/2022
Print ISSN: 1531-3433
Elektronische ISSN: 1534-3081
DOI: https://doi.org/10.1007/s11916-022-01009-x

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Enhanced Recovery After Surgery: Opioid Sparing Strategies After Discharge: A Review