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Opioids in the Perioperative Setting: Should We Be Worried?

The opioid epidemic is one of the only public health problems that continues to worsen throughout the world. While much of the focus has been placed on primary care and chronic pain prescribing, most people receive their first opioid exposure from an acute care episode, such as surgery. While opioids remain an important part of anesthesia and postoperative care, physicians have prescribed opioids after surgery far in excess of patient needs due to a lack of guidelines on optimal analgesia, follow-up and failure to recognize the potential for morbidity. Studies both in the US and Europe have shown that becoming a new chronic opioid user is the most common complication after elective surgery and yet a complication that surgeons have not previously discussed with their patients.

In this workshop, we will discuss how opioid prescribing for surgery and other acute care directly contributes to short- and long-term morbidity. We will further discuss the importance of balancing opioid use perioperatively to treat post-operative pain and the potential for acute and chronic side effects. Lastly, we will explore the neuroscience for addiction and response to opioids using data from cutting edge neuroimaging techniques, to discuss future areas for improvement.

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The Role of Acute Care Prescribing in the Opioid Epidemic

Dr. Brummett will discuss how prescribing after surgery has directly impacted the opioid epidemic in the US and Canada and how the same factors that increased prescribing and morbidity is currently spreading around the world due to changes in opioid prescribing and postoperative care patterns. He will show that while increased opioid prescribing after surgery does not improve pain or satisfaction, it is associated with increased new chronic use, morbidity and cost of care.

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Opioid Related Complications in the Perioperative Setting – a Deal with the Devil?

Reducing pain is crucial to increase physical and cognitive function after surgery, but choosing the right strategy is difficult since analgesic efficacy often comes at a cost in the form of increased side-effects. Dr. Aasvang will discuss the dilemma between opioids being the most potent analgesic drug and the workhorse of present-day clinical analgesia versus the well-documented adverse effects hindering recovery and abuse risk. Data on how pre- and postoperative opioid use are related to acute and persistent postoperative complications across all organ systems will be presented, including the transition from acute to persistent postoperative pain. Suggestions for opioid sparing analgesic strategies, the need for an active role of physicians in follow-up and the consequences on rehabilitation will be presented. He will further discuss the potential for individualized pain risk assessment strategies, to personalize analgesia and reduce side-effects.

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A Personalized Approach to Opioid use Based on Brain Networks

Dr. Tracey will describe a growing body of literature aimed at understanding how variances in brain networks and psychological profiling relate to the magnitude of opioid analgesia and addiction propensity. She will draw on work from human neuroimaging and preclinical studies from the pain and addiction literature. She will also discuss how long-term opioid use and opioid withdrawal affects brain networks. This will facilitate discussion around the potential for more careful stratification of patients for opioid use based upon individual brain networks.

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