Chronic Opioid Use After Surgery: Implications for Perioperative Management in the Face of the Opioid Epidemic
Open accessAbstract
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.
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An increasing number of surgical patients remain on prescription opioids longer than is medically indicated.
“However, an increasing number of patients undergoing surgery are remaining on prescription opioids for longer periods than medically indicated12.”
From Acceptance and Commitment Therapy for Prevention of Chronic Postsurgical Pain and Opioid Use in At-Risk Veterans: A Pilot Randomized Controlled Study. (2018) · cites this paper as [12]
The “Persistent or Chronic Opioid Use After Surgery” section reports that postoperative prescriptions can lead to long-term opioid use. “Risks Associated with Opioid Use after Surgery” also reports that some patients in surgical clinics used opioids longer than prescribed. Neither passage establishes that an increasing number of surgical patients do so, or that their duration of use exceeds what is medically indicated; the Introduction’s prescribing trend concerns opioids overall. (LLM, conf=0.85)
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- Authors
- Hah, J. M., Bateman, B. T., Ratliff, J., Curtin, C., & Sun, E.
- Affiliations
- Stanford Medicine (US)
- Brigham and Women's Hospital (US)
- Stanford University (US)
- Corresponding author
- Hah, Jennifer M.
- Venue
- Anesthesia & Analgesia
- Published
- 2017-11
- Volume
- 125
- Issue
- 5
- Pages
- 1733-1740
- ISSN
- 0003-2999 (ISSN-L)
- PMC
- PMC6119469
- OpenAlex
- W2765742218
- Cited by
- 728
- References
- 114
- Citations by year
- 2026: 54 · 2025: 87 · 2024: 94 · 2023: 76 · 2022: 111 · 2021: 118 · 2020: 105 · 2019: 59 · 2018: 22 · 2017: 1
- FWCI
- 8.31
- Type
- journal article
- Language
- en
- Open access
- green
- europepmc.org
- Locations
- Anesthesia & Analgesia (publishedVersion)
- PubMed (publishedVersion)
- Europe PMC (PubMed Central) (acceptedVersion)
- PubMed Central (acceptedVersion)
- Funders
- Curtin University of Technology
- National Institutes of Health
- National Institute on Drug Abuse (K23DA035302, K08DA042314)
- Eunice Kennedy Shriver National Institute of Child Health and Human Development (K08HD075831)
- Topics
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Opioid Use Disorder Treatment
- Health Sciences › Medicine › Surgery › Anesthesia and Pain Management
- Health Sciences › Medicine › Anesthesiology and Pain Medicine › Pain Management and Opioid Use
- Keywords
- opioid epidemic, perioperative care, postoperative pain, nerve block, risk factors, opioid overdose, chronic pain, anesthesiology
- MeSH terms
- Analgesics, Opioid, Combined Modality Therapy, Drug Administration Schedule, Humans, Opioid-Related Disorders, Pain Measurement, Postoperative Pain, Patient Care Team, Risk Factors, Treatment Outcome, Risk Assessment, Analgesics, Non-Narcotic, Delivery of Health Care, Integrated, Perioperative Care, Epidemics, Prescription Drug Misuse
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