Dr Ning Nan Wang introduces @harshamd5 to open the chronic pain session: Perioperative use of opioid in the context of Opioid Epidemic. #CASAM2023
The opioid crisis isn’t new - China probably remembers the Opium wars that helped establish a British foothold on the continent. Opioids and OUR crisis. Is what we fear the real crisis? Are opioid-related deaths due to surgical prescriptions? No, mostly due to street fentanyl.… twitter.com/i/web/status/1…
Opioid use around the time of surgery. Understanding nociception vs pain. Does eliminating opioids during surgery make a difference - no definitive conclusions. #CASAM2023
Okay, say there was value in reducing opioids - what’s in a name? Multimodal analgesia does not include complete avoidance of opioids. Removing opioids prolongs recovery. #CASAM2023
An important point - differentiating analgesics from adjuvants, and what is their overall value? Opioid free anesthesia MOVEMENT (sort of like a cult but nicer? 😉) - hype due to contextual interpretation. The puzzle pieces don’t really fit. #CASAM2023
Multiple pathways. Several bundles, which to choose? Recipes raise questions. #CASAM2023
Questioning the evidence - no clinically significant difference in PONV despite opioid group not being given antiemetics. Pain itself can cause PONV. Problems with intraoperative pain. Longer recovery. Non-inferiority vs equivalence vs superiority, oh my. Primary outcome similar,… twitter.com/i/web/status/1…
No clinical benefits with OFA. And then we consider postoperative analgesia (where #AnyAnes ceases to have impact?) Procedure specific analgesia requirements, individual variability. 3 cohorts of patient responses postoperatively: pain decreases, pain plateaus and pain increases… twitter.com/i/web/status/1…
Differences between US patients and international groups. It is perceived that OFA will translate to decreased persistent opioid use and lower long term complications. But pre- and intraoperative opioids are not associated with postoperative pain trajectory. Studying prolonged… twitter.com/i/web/status/1…
Postoperative opioid use (where problem lies?) not studied. Short follow-up durations hamstring OFA studies. Surgical opioid prescription-need and issue: barriers to guideline based prescriptions. #CASAM2023
Key messages from @harshamd5. #CASAM2023
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