Current Topics: Opioid Focus
NEW!! ASA Pain: Anesthesiologists Tailored Approach to Patient Safety Considerations On Demand
We owe it to patients to help ensure health care providers have the knowledge they need to keep patients safe. Discover best practices for managing pain as well as safe and appropriate opioid prescribing by participating in this Opioid Analgesic educational course, based off of the FDA’s current Opioid Analgesic REMS Education Blueprint for Health Care Providers Involved in the Treatment and Monitoring of Patients with Pain.
Discover how to:
- Maintain patient access to appropriate pain medications while reducing the negative outcomes associated with inappropriate prescribing, misuse and abuse of opioid analgesics.
- Recognize signs of opioid misuse, abuse and addiction.
- Develop strategies for pain management and safe use of opioid analgesics when appropriate.
- Expand your learning with a unique combination of didactic, interactive case-based questions, problem-based learning (PBL) and simulated patient–caregiver interviews. Plus, engage in expert faculty panel discussions.
This course has been approved by:
- The Wisconsin Medical Examining Board as meeting the requirements for a continuing education course on the responsible opioid prescribing guidelines per Med 13.03(3) of the Wisconsin Administrative Code.
- The Medical Licensing Board of Indiana as meeting the requirements for a continuing education course on opioid prescribing and opioid abuse.
Expiration Date: 12/31/2019
2018 Refresher Courses in Anesthesiology - October - Optimizing Pain Control and Minimizing Opioid Use Following Cesarean Delivery in Breastfeeding Parturients
This lecture summarizes various multi-modalanalgesic options to optimize pain managementpost-cesarean delivery. The role of neuraxialopioids, non-steroidal anti-inflammatories, acetaminophen, gabapentin, wound infiltration, transversus abdominis plane block, and futureanalgesic options will be reviewed. Analgesic drug exposure in breastfeeding neonates, andtechniques to minimize the transfer of analgesics into breast milk will also bediscussed.
Expiration Date: 10/22/2021
Journal CME - 2018 May
Journal CME - 2018 May Background: Multimodal analgesia is increasingly considered routine practice in joint arthroplasties, but supportive largescale data are scarce. The authors aimed to determine how the number and type of analgesic modes is associated with reduced opioid prescription, complications, and resource utilization. Methods: Total hip/knee arthroplasties (N = 512,393 and N = 1,028,069, respectively) from the Premier Perspective database (2006 to 2016) were included. Analgesic modes considered were opioids, peripheral nerve blocks, acetaminophen, steroids, gabapentin/pregabalin, nonsteroidal antiinflammatory drugs, cyclooxygenase-2 inhibitors, or ketamine. Groups were categorized into “opioids only” and 1, 2, or more than 2 additional modes. Multilevel models measured associations between multimodal analgesia and opioid prescription, cost/length of hospitalization, and opioid-related adverse effects. Odds ratios or percent change and 95% CIs are reported. Results: Overall, 85.6% (N = 1,318,165) of patients received multimodal analgesia. In multivariable models, additions of analgesic modes were associated with stepwise positive effects: total hip arthroplasty patients receiving more than 2 modes (compared to “opioids only”) experienced 19% fewer respiratory (odds ratio, 0.81; 95% CI, 0.70 to 0.94; unadjusted 1.0% [N = 1,513] vs. 2.0% [N = 1,546]), 26% fewer gastrointestinal (odds ratio, 0.74; 95% CI, 0.65 to 0.84; unadjusted 1.5% [N = 2,234] vs. 2.5% [N = 1,984]) complications, up to a –18.5% decrease in opioid prescription (95% CI, –19.7% to –17.2%; 205 vs. 300 overall median oral morphine equivalents), and a –12.1% decrease (95% CI, –12.8% to –11.5%; 2 vs. 3 median days) in length of stay (all P < 0.05). Total knee arthroplasty analyses showed similar patterns. Nonsteroidal antiinflammatory drugs and cyclooxygenase-2 inhibitors seemed to be the most effective modalities used. Conclusions: While the optimal multimodal regimen is still not known, the authors’ findings encourage the combined use of multiple modalities in perioperative analgesic protocols.
Expiration Date: 04/16/2021
Journal CME - 2018 July
Background: The value of intravenous acetaminophen in postoperative pain management remains debated. The authors tested the hypothesis that intravenous acetaminophen use, in isolation and in comparison to oral, would be associated with decreased opioid utilization (clinically significant reduction defined as 25%) and opioid-related adverse effects in open colectomy patients. Methods: Using national claims data from open colectomy patients (Premier Healthcare Database, Premier Healthcare Solutions, Inc., USA; 2011 to 2016; n = 181,640; 602 hospitals), we separately categorized oral and intravenous acetaminophen use: 1 (1,000 mg) or more than 1 dose on the day of surgery, postoperative day 1, or later. Multilevel models measured associations between intravenous or oral acetaminophen and (1) opioid utilization and (2) opioid-related adverse effects. Percent change and multiplicity-adjusted 99.5% CI are reported. Results: Overall, 25.1% of patients received intravenous acetaminophen, of whom 48.0% (n = 21,878) received 1 dose on the day of surgery. In adjusted analyses, particularly more than 1 dose of intravenous acetaminophen (versus nonuse) on postoperative day 1 was associated with a -12.4% (99.5% CI, -15.2 to -9.4%) change in opioid utilization. In comparison, a stronger reduction was seen in those receiving more than 1 oral acetaminophen dose: -22.6% (99.5% CI, -26.2 to -18.9%). Unadjusted group medians were 550 and 490 oral morphine equivalents, respectively. Intravenous versus oral differences were less pronounced among those receiving more than 1 acetaminophen dose on the day of surgery: -8.0% (99.5% CI, -11.0 to -4.9%) median 499 oral morphine equivalents versus -8.7% (99.5% CI, -14.4 to -2.7%) median 445 oral morphine equivalents, respectively; all statistically significant, but none clinically significant. Comparable outcome patterns existed for opioid-related adverse effects. Conclusions: The demonstrated marginal effects do not support routine use of intravenous acetaminophen given alternative nonopioid analgesic options.
Expiration Date: 06/18/2021