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Monitoring of Opioid Analgesic Use and Its Effects in Acute Care

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Opioid Use in Critical Care

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Abstract

There has been a dramatic rise in deaths attributed to opioid use in the last decade, and with the recognition of prescription opioids as a significant contributor, the use of opioids in healthcare has become heavily scrutinized. However, despite a renewed interest in opioid sparing multimodal pain management strategies, opioids remain the most effective pain modality for severe acute pain. Also, with national guidelines emphasizing analgo-sedation (treat pain first), opioids are the cornerstone of sedation and analgesia practices in intensive care units. However, in the absence of appropriate cardiorespiratory monitoring, the side-effect profile of opioids can have dire consequences. Over the past decade, opioid consumption and adverse event prevention have been studied extensively with new technologies emerging to assist clinical decision making. Algorithms and protocols have been standardized taking many factors into consideration prior to subjectively determining if a verbal or nonverbal patient has adequate pain control. We here present an overview of the technology available to monitor opioid use and overdose, algorithms for various grades of sedation, personnel expertise, and certification required to safely administer opioids in acute care setting and methods to identify at-risk patient groups.

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Notes

  1. 1.

    Excerpted from Statement of Granting Privileges for Administration of Moderate Sedation to Practitioners, 2016, of the American Society of Anesthesiologists. A copy of the full text can be obtained from ASA, 1061 American Lane Schaumburg, IL 60173–4973 or online at www.asahq.org

  2. 2.

    Excerpted from Advisory on Granting Privileges for Deep Sedation to Non-Anesthesiologist Physicians, 2017, of the American Society of Anesthesiologists. A copy of the full text can be obtained from ASA, 1061 American Lane Schaumburg, IL 60173–4973 or online at www.asahq.org

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Author information

Authors and Affiliations

  1. Department of Anesthesiology, Cooper University Hospital, Cooper Medical School of Rowan University, Camden, NJ, USA

    Akhil Patel

  2. Department of Anesthesiology and Pain Management, UT Southwestern Medical Center, Dallas, TX, USA

    Kunal Karamchandani

  3. Department of Anesthesiology, Section on Critical Care Medicine, Wake Forest School of Medicine, Wake Forest Baptist Medical Center, Winston-Salem, NC, USA

    Ashish K. Khanna

  4. Outcomes Research Consortium, Cleveland, OH, USA

    Ashish K. Khanna

Authors
  1. Akhil Patel
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  2. Kunal Karamchandani
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  3. Ashish K. Khanna
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Corresponding author

Correspondence to Ashish K. Khanna .

Editor information

Editors and Affiliations

  1. Professor of Surgery and Neurosurgery, Perelman School of Medicine Clinical Associate, School of Nursing, University of Pennsylvania, Philadelphia, PA, USA

    Jose L. Pascual

  2. Department of Anesthesiology and Critical Care, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA

    Timothy G. Gaulton

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Patel, A., Karamchandani, K., Khanna, A.K. (2021). Monitoring of Opioid Analgesic Use and Its Effects in Acute Care. In: Pascual, J.L., Gaulton, T.G. (eds) Opioid Use in Critical Care. Springer, Cham. https://doi.org/10.1007/978-3-030-77399-1_7

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  • DOI: https://doi.org/10.1007/978-3-030-77399-1_7

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  • Online ISBN: 978-3-030-77399-1

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