Preventing opioid prescription after major surgery: a scoping review of opioid-free analgesia

Julio F Fiore Jr; Ghadeer Olleik; Charbel El-Kefraoui; Bernardo Verdolin; Araz Kouyoumdjian; Allison Alldrit; Ana G Figueiredo; Sofia Valanci; Javier A Marquez-GdeV; Matthew Schulz; Dan Moldoveanu; Philip Nguyen-Powanda; Gordon Best; Alexander Banks; Tara Landry; Nicolò Pecorelli; Gabriele Baldini; Liane S Feldman

doi:10.1016/j.bja.2019.08.014

Preventing opioid prescription after major surgery: a scoping review of opioid-free analgesia

Br J Anaesth. 2019 Nov;123(5):627-636. doi: 10.1016/j.bja.2019.08.014. Epub 2019 Sep 25.

Authors

Julio F Fiore Jr¹, Ghadeer Olleik², Charbel El-Kefraoui³, Bernardo Verdolin², Araz Kouyoumdjian⁴, Allison Alldrit⁵, Ana G Figueiredo², Sofia Valanci², Javier A Marquez-GdeV⁶, Matthew Schulz⁷, Dan Moldoveanu⁸, Philip Nguyen-Powanda⁹, Gordon Best⁷, Alexander Banks⁷, Tara Landry¹⁰, Nicolò Pecorelli³, Gabriele Baldini¹¹, Liane S Feldman¹²

Affiliations

¹ Steinberg-Bernstein Centre for Minimally Invasive Surgery and Innovation, McGill University Health Centre, Montreal, QC, Canada; Department of Surgery, McGill University, Canada McGill University, Montreal, QC, Canada; Division of Experimental Surgery, McGill University, Canada McGill University, Montreal, QC, Canada; Centre for Outcomes Research and Evaluation, Research Institute of the McGill University Health Centre, Montreal, QC, Canada. Electronic address: julio.fiorejunior@mcgill.ca.
² Steinberg-Bernstein Centre for Minimally Invasive Surgery and Innovation, McGill University Health Centre, Montreal, QC, Canada; Division of Experimental Surgery, McGill University, Canada McGill University, Montreal, QC, Canada.
³ Steinberg-Bernstein Centre for Minimally Invasive Surgery and Innovation, McGill University Health Centre, Montreal, QC, Canada.
⁴ Steinberg-Bernstein Centre for Minimally Invasive Surgery and Innovation, McGill University Health Centre, Montreal, QC, Canada; Faculty of Medicine, McGill University, Montreal, QC, Canada.
⁵ Steinberg-Bernstein Centre for Minimally Invasive Surgery and Innovation, McGill University Health Centre, Montreal, QC, Canada; Ingram School of Nursing, McGill University, Montreal, QC, Canada.
⁶ Division of Experimental Surgery, McGill University, Canada McGill University, Montreal, QC, Canada.
⁷ Faculty of Medicine, McGill University, Montreal, QC, Canada.
⁸ Department of Surgery, McGill University, Canada McGill University, Montreal, QC, Canada; Division of Experimental Surgery, McGill University, Canada McGill University, Montreal, QC, Canada.
⁹ Faculty of Sciences, McGill University, Montreal, QC, Canada.
¹⁰ Medical Libraries, McGill University Health Centre, Montreal, QC, Canada.
¹¹ Division of Experimental Surgery, McGill University, Canada McGill University, Montreal, QC, Canada; Department of Anesthesia, McGill University, Canada McGill University, Montreal, QC, Canada.
¹² Steinberg-Bernstein Centre for Minimally Invasive Surgery and Innovation, McGill University Health Centre, Montreal, QC, Canada; Department of Surgery, McGill University, Canada McGill University, Montreal, QC, Canada; Division of Experimental Surgery, McGill University, Canada McGill University, Montreal, QC, Canada; Centre for Outcomes Research and Evaluation, Research Institute of the McGill University Health Centre, Montreal, QC, Canada.

PMID: 31563269
DOI: 10.1016/j.bja.2019.08.014

Abstract

Background: Excessive opioid prescribing after surgery has been recognised as a contributor to the current crisis of opioid addiction and overdose. Clinicians may potentially tackle this crisis by using opioid-free postoperative analgesia; however, the scientific literature addressing this approach is sparse and heterogeneous, thereby limiting robust conclusions. A scoping review was conducted to systematically map the extent, range, and nature of the literature addressing postoperative opioid-free analgesia.

Methods: Eight bibliographic databases were searched for studies addressing opioid-free analgesia after a major surgery. We extracted the study characteristics, including design, country, year, surgical procedure(s), and interventions. Results were organised thematically according to surgical specialty and targeted phase of recovery: in hospital (early recovery, ≤24 h after operation; intermediate recovery, >24 h) and post-discharge (late recovery). Reporting was according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement for scoping reviews.

Results: We identified 424 studies addressing postoperative opioid-free analgesia. The number of studies conducted in countries where the opioid crisis is primarily focused was remarkably low (USA, n=11 [3%]; Canada, n=5 [1%]). Many RCTs compared opioid-free vs opioid analgesia during hospital stay (n=117), but few targeted analgesia post-discharge (n=8). Studies were predominantly focused on procedures in orthopaedic, general, and gynaecological/obstetric surgery. Limited attention has been directed towards non-pharmacological pain interventions. We did not identify knowledge synthesis studies (i.e. systematic reviews and meta-analyses) focused on the comparative effectiveness of opioid-free vs opioid analgesia.

Conclusions: Opioids remain a mainstay analgesic for managing pain after surgery, but alternative analgesia strategies should not be overlooked. This scoping review indicates numerous opportunities for future research targeting opioid-free postoperative analgesia. REVIEW REGISTRATION: http://www.researchregistry.com; ID: reviewregistry576.

Keywords: analgesia; opioids; pain management; postoperative; postoperative pain; surgery.

Publication types

Research Support, Non-U.S. Gov't
Review

MeSH terms

Analgesics, Non-Narcotic / administration & dosage*
Analgesics, Opioid / administration & dosage*
Drug Utilization / statistics & numerical data
Humans
Opioid-Related Disorders / prevention & control*
Pain Management / methods
Pain, Postoperative / prevention & control*
Postoperative Care / methods
Practice Patterns, Physicians' / statistics & numerical data*

Substances

Analgesics, Non-Narcotic
Analgesics, Opioid

Grants and funding

CIHR/Canada