Perioperative opioid use

Perioperative opioid use, historically a mainstay of anesthetic and analgesic management, has been questioned over the last decade. The new thinking is based on preclinical and volunteer studies suggesting that even brief opioid administration can lead to neuroadaptation causing opioid tolerance and opioid-induced hyperalgesia. Clinical studies seem to support the applicability of the concepts of opioid tolerance and opioid-induced hyperalgesia to the perioperative setting. Consequently, opioid-free anesthesia was quickly implemented into clinical practice under the assumption that this intervention will reduce the need for opioid prescriptions at discharge and lower the risk of prolonged opioid use and postoperative chronic pain. At the same time, the movement toward opioid-free anesthesia has been criticized with concerns that there is no evidence for a reduced risk of prolonged opioid use following opioid-free anesthesia. Opioid-free intraoperative techniques might in fact introduce new perioperative risks that need to be understood and weighed against potential benefits. The long-term goal of our research is to improve our understanding of the effects of opioid-free anesthesia techniques on postoperative pain and opioid prescriptions over one year after surgery and to contribute to the identification of safe and efficient opioid use intraoperatively if even needed at all.