• Posted June 20, 2023

Cutbacks on Opioids Around Surgery May Do More Harm Than Good

Many doctors have stopped giving opioids for pain, even during surgery, because of the opioid addiction crisis in the United States. But a new study questions the wisdom of this approach.

Restricting the drugs during surgery may do more harm than good, researchers report.

“The opioid crisis is a major motivator for mitigating the risks of opioid usage,” said study co-author Dr. Laura Santa Cruz Mercado, who was a research fellow at Massachusetts General Hospital (MGH) at the time of the study.

“But appropriate opioid administration in the operating room may reduce total opioid usage after surgery," she added in a hospital news release.

She and her colleagues analyzed information on more than 61,000 adults who had surgery at MGH between 2016 and 2020.

They found that patients who were administered more of the opioids fentanyl and hydromorphone during surgery were less likely to experience pain. These patients also used fewer opioids in the hospital after waking up from anesthesia.

Patients who received higher amounts of fentanyl were less likely to experience uncontrolled pain or to have a new chronic pain diagnosed within three months of surgery, the study found. They were also less likely to be prescribed opioids at 30, 90 and 180 days after surgery and less likely to develop new persistent opioid use. This was all seen without an increase in adverse effects.

This work was funded in part by the U.S. National Institutes of Health. The findings were published June 14 in the journal JAMA Surgery.

It's important that patients not emerge from general anesthesia in pain, the research suggests. This is vital not only for their short-term well-being, but also to safeguard against persistent pain and the need for prolonged opioid use, researchers said.

Additional research is needed to provide more clear guidance to surgical teams, said study co-author Patrick Purdon, an associate professor of anesthesia at Harvard Medical School.

“We need to develop new technologies to help anesthesiologists titrate and optimize opioid administration in the operating room in a personalized way,” Purdon said. “But this data gives us evidence that such efforts could have significant long-term benefits."

More information

The U.S. Department of Health and Human Services offers some facts on opioids.

SOURCE: Massachusetts General Hospital, news release, June 15, 2023