Analgesia for the Substance Use Disorder Patient Using Opioid Sparing Anesthesia

UNCG Author/Contributor (non-UNCG co-authors, if there are any, appear on document)
Jason Mitchell (Creator)
Institution
The University of North Carolina at Greensboro (UNCG )
Web Site: http://library.uncg.edu/
Advisor
Joshua Borders

Abstract: Opioids have been a primary analgesic in anesthesia for numerous years but have many well-known undesirable side effects. Opioid receptors are located in the central nervous system and when activated, lead to hyperpolarization and inhibit neuronal activity (Bajwa et al., 2017). Transmission of signals from the peripheral pain neurons is reduced as it travels to higher central nervous system centers providing a reduction in the sensation of pain. Unfortunately, opioid agonists also stimulate the chemoreceptor trigger zone leading to nausea and vomiting (Bajwa et al., 2017; Fawcett & Jones, 2018). Other unwanted effects include excessive sedation, ileus, respiratory depression, pruritus, urinary retention, and a large potential for abuse, misuse, and physical dependency (Brandal et al., 2017; Enten et al., 2019; Guinot et al., 2019; Jebaraj et al., 2017; Velasco et al., 2019). Newer evidence also indicates increasing reports of other concerning adverse reactions such hyperalgesia, immunosuppression, infection, and increased risk of tumor recurrence (Estebe et al., 2021; Guinot et al., 2019; Lavand’homme & Steyaert, 2017; Wilson, 2019). These adverse effects can increase times in the recovery/post anesthesia care unit (PACU), increase length of hospital stay, increase morbidity and mortality, and increase hospital costs (Guinot et al., 2019; Jebaraj et al., 2017; Velasco et al., 2019). Opioid misuse has led to the opioid epidemic in the United States with 16,000 deaths per year attributed to prescription opioids. An estimated 1 in 16 post-surgical patients become chronic opioid users (Brummett et al., 2017; Nelson et al., 2015). Additionally, opioids contribute to thousands of deaths each year with the ongoing opioid epidemic in North America (Center for Disease Control and Prevention, 2021).

Additional Information

Publication
Other
Language: English
Date: 2023
Keywords
Opioid sparing, Anesthesia, Substance Use Disorder Patients

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