Opioid-specific counseling and perioperative intravenous infusions were among the efficacious methods identified for combating rising opioid consumption following gastrointestinal (GI) surgery, according to study results published in Surgery in Practice and Science.
Researchers conducted a systematic review that included 1687 individuals (mean age, 50 years) from 14 prospective randomized controlled trials (RCTs) published between 1994 and 2021. Potential bias was examined using the Risk of Bias 2.0 assessment.
Among the 14 total studies, 6 reported outcomes related to intravenous analgesic infusion and its impact on opioid consumption at the time of discharge. Of these, 5 reported an association between using a preoperative bolus/continuous infusion and a lower requirement for opioids. Reduced opioid consumption levels following intravenous infusions were unanimously reported by all 3 studies that included this outcome.
Among the 3 studies reporting outcomes after laparoscopic surgery, 2 out of 3 reported reduced opioid consumption levels. Of the 4 studies reporting on the role of oral medications in reducing postoperative opioid consumption, only 1 trial reported oral vitamin C supplementation as having a significant effect compared with placebo. One trial outlined the effect of analgesia controlled by participants, intramuscular anti-inflammatory gels, ultrasound-guided nerve blocks, and opioid-targeted counseling in reducing postoperative opioid consumption.
Study limitations included heterogeneity between studies, the inclusion of only 1 study assessing opioid-specific counseling after GI surgery, the exclusion of potentially useful nonrandomized studies, and the need for further validation of the time and cost-efficiency of opioid-specific counseling.
“Among the most promising of novel avenues worth exploring are educational opioid-specific counseling and the perioperative prescription of intravenous infusions to counteract the increasing opioid consumption…,” the study authors wrote.
Davey MG, Joyce WP. Reducing opioid consumption levels post-operatively following gastrointestinal surgery – a systematic review of randomized trials. Surg Pract. Published online May 29, 2022. doi:10.1016/j.sipas.2022.100093