Amidst the opioid-epidemic storm: reflections of a non-opioid anesthesiologist

A recent blog post by TeamHealth reviews a discussion with David Samuels, MD, on his thoughts from a non-opioid anesthesiologist's perspective. 

Editor's Note: This article originally appeared on TeamHealth's website

In 2016, Surgeon General, Vivek Murthy, MD, sent a letter to every physician in the United States enlisting our commitment to help end the opioid epidemic. He stated that the crisis was born from a “path of good intentions.” For decades, physicians were encouraged by various pain organizations, government agencies and big pharma to be more aggressive about treating pain. Dr. Murthy highlighted routine surgery as a potential gateway for opioid use disorder. Recent literature demonstrated that 6-8 percent of patients remain on opioids more than 90 days after major or minor surgery. Should anesthesiologists be concerned about our contribution to the initiation of opioid tolerance during surgery?

I recently removed fentanyl (and all opioids) from my general anesthesia practice to mitigate opioid-induced deaths from respiratory depression known as “dead-in-bed” syndrome. A feature of the non-opioid general anesthetic is that patients utilize fewer opioids in the recovery room. The scientific evidence for acute opioid-induced hyperalgesia (paradoxical increased pain) is decades old, but its clinical significance has been difficult to prove. That even a small dose of intraoperative opioid can lead to more than double the opioid requirement in the recovery room might be explained by opioid-induced hyperalgesia. Additionally, the decreased nausea and vomiting rate leads to earlier home readiness. Click here to continue>>

 

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