In response to the growing opioid epidemic, many states have adopted prescribing guidelines from the Centers for Disease Control and Prevention (CDC). Prescription drug monitoring programs (PDMPs) have been intensified to increase oversight and help medical professionals to make more informed prescribing decisions.1 And new laws and regulations have been enacted to reduce the number of unused, misused, and diverted prescriptions in our midst. For example2:
- 19 states have implemented day supply limits to written opioid prescriptions
- 34 states now require a substance abuse disorder assessment prior to opioid prescription
- 36 states allow (or even mandate) pharmacists to check a patient’s ID before dispensing prescriptions
The challenge for anesthesiologists
These regulations help to protect patients and prevent diversion by limiting the use of opioids. But adequate management of acute pain is still an essential part of recovery from any surgery:
- Postoperative pain has been shown to have a negative impact on physical activity, sleep, and cognitive function.3
- Patients with higher postoperative pain at rest were significantly less likely to ambulate 72 hours following surgery and continued to show lower locomotion scores at 6 months.4
- Inadequate management can delay discharge for patients.4
- Increased pain severity has been associated with lower patient satisfaction.5
To ensure a smooth, successful, and comfortable postoperative recovery for their patients, anesthesiologists must find powerful non-opioid alternatives for pain relief.
- Knee arthroplasty
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References: 1. Rusher JW. Monitoring programs, state regulations help physicians prescribe opioids responsibly. AAP Gateway. http://www.aappublications.org/news/2018/12/26/law122618. Published January 17, 2019. Accessed January 22, 2019. 2. Infographic: State-by-state breakdown of opioid regulations. athenahealth. https://www.athenahealth.com/insight/infographic-opioid-regulations-state-by-state. Published January 7, 2019. Accessed January 22, 2019. 3. Aasvang EK, Luna IE, Kehlet H. Challenges in postdischarge function and recovery: the case of fast-track hip and knee arthroplasty. Br J Anaesth. 2015;115(6):861-866. doi:10.1093/bja/aev257. 4. Morrison RS, Magaziner J, McLaughlin MA. The impact of post-operative pain on outcomes following hip fracture. Pain. 2003;103(3):303-311. doi:10.1016/S0304-3959(02)00458-X. 5. Chan EY, Blyth FM, Nairn L, et al. Acute postoperative pain following hospital discharge after total knee arthroplasty. Osteoarthritis Cartilage. 2013;21(9):1257-1263. doi:10.1016/j.joca.2013.06.011.