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O U T P A T I E N T S U R G E R Y M A G A Z I N E O N L I N E | J U N E 2 0 1 5
We know that opioids help
reduce nociceptive pain, but at
what cost? The list of undesir-
able side effects is long and
troublesome.
In a review
(osmag.net/UgtK7X) of 6
studies involving 1,342 partici-
pants who'd undergone vari-
ous procedures, we found that
patients given a combination
of ibuprofen plus high-dose codeine experienced significantly higher rates of pain
relief than patients given a placebo. Not surprising. But interestingly, we also found
that patients who were given 400 mg of ibuprofen plus codeine fared only slightly
better in pain relief than patients who were given the same dose of ibuprofen
alone. In fact, the difference was just barely statistically significant.
It's all the more reason to consider whether the benefits of opioids are likely
to be commensurate with the disadvantages. For example, we know that patient
satisfaction depends on more than pain control. Those who experience PONV, a
common side effect associated with opioids, may be just as dissatisfied as those
who experience pain. Patients given opioids may also experience
respiratory depression, urinary retention and constipation. Misuse and abuse are
also profound concerns.
Taken together, these facts and findings appear to further underscore the need to
reduce traditional reliance on opioid analgesics, and to shift their role to that of res-
cue agents instead.
— Jaime Baratta, MD
WORTH THE COST?
Do Opioids Add as Much as They Subtract?
z ONLY IF NEEDED The multimodal approach
reduces opioids to an adjunct instead of a mainstay.
