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Post-operative Weaning of Opioids After Ambulatory Surgery: the Importance of Physician Stewardship

  • Other Pain (A Kaye and N Vadivelu, Section Editors)
  • Published:
Current Pain and Headache Reports Aims and scope Submit manuscript

Abstract

Purpose of Review

We performed a systematic review to elucidate the current guidelines on weaning patients from opioids in the post-operative ambulatory surgery setting, and how pain management intraoperatively can impact this process.

Design

The review highlights the most up-to-date research from clinical trials, patient reports, and retrospective studies regarding both the current guidelines and weaning of opioid analgesia in ambulatory surgery setting.

Recent Findings

A striking paucity of convincing evidence exists on ambulatory postoperative pain management discontinuation or weaning of pain medications. However, retrospective and patient-reported studies suggest our approach should be similar to acute pain management strategies. The first steps include identifying high-risk patients and devising an appropriate pain plan. This may be accomplished by implementing multimodal analgesia, anticipating opioid needs, and the proper use of regional anesthesia. The increasing roles for Transitional Pain Service (TPS), Perioperative Surgical Home (PSH), and Enhanced Recovery After Surgery (ERAS) may also guide us in this process.

Summary

Patients discharged from same-day surgery may lack the additional infrastructure of a hospital or medical establishment to monitor postoperative recovery. As such, weaning of pain medications in ambulatory surgery settings requires teams that are adept at treating varied patient populations through a tailored, novel means that invoke multimodal analgesia. Given the growth of surgeries moving toward the ambulatory sector, more data and practice guidelines are needed to direct postoperative pain regimen titration for the patients.

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Authors and Affiliations

  1. Department of Anesthesiology, Yale University School of Medicine, 333 Cedar Street, TMP 3, P.O. Box 208051, New Haven, CT, 065, USA

    Brandon Roth, Adjoa Boateng, Allison Berken, Daniel Carlyle & Nalini Vadivelu

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  1. Brandon Roth
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  2. Adjoa Boateng
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  3. Allison Berken
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Correspondence to Brandon Roth.

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Brandon Roth, Adjoa Boateng, Allison Berken, Daniel Carlyle, and Nalini Vadivelu declare no conflict of interest.

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This article does not contain any studies with human or animal subjects performed by any of the authors.

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This article is part of the Topical Collection on Other Pain

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Roth, B., Boateng, A., Berken, A. et al. Post-operative Weaning of Opioids After Ambulatory Surgery: the Importance of Physician Stewardship. Curr Pain Headache Rep 22, 40 (2018). https://doi.org/10.1007/s11916-018-0694-4

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