Many patients who present for surgery and are already taking opioids are at increased risk of adverse effects, including difficulties in weaning postoperatively. This article outlines how to manage opioid use in patients before and after surgery and how to successfully wean them off their opioids.
- Opioid use is common in patients waiting for surgery but does not considerably improve pain or function and can lead to higher opioid doses and difficulties with opioid weaning after surgery.
- Patients with anxiety and depression are more likely to use opioids before surgery and experience issues after surgery; identification and management of these conditions can help pain management.
- It is important that GPs identify any shift from acute pain to chronic noncancer pain after surgery and reassess analgesic strategies, including discussing risks, benefits, expectations, treatment goals and triggers for weaning.
- Hospital opioid stewardship programs that match prescribing at discharge to actual usage of opioids in the previous one to two days do not reduce patient satisfaction with analgesia or increase GP refill prescriptions.
- Opioid weaning is more successful when initiated by the patient, and patients should be educated on the benefits of weaning before major surgery.
- For patients taking high-dose opioids, supervised opioid agonist therapy with buprenorphine can improve pain and quality of life.