Optimising the management of perioperative opioid analgesics

Perioperative administration of opioids is not without consequences and will affect patients' postoperative recovery in term of function, risk of persistent post-surgical pain as well as longterm opioids use and misuse. The role of the anaesthesiologists in the "opioids crisis" has been pointed out but they are neither the only ones nor the biggest prescribers. The reduction and the control of perioperative opioids prescription represent a major challenge as well as a unique opportunity to question and to optimise actual patients perioperative management. The anaesthesiologists have a crucial role to play in the education of both patients and healthcare providers. Balanced anaesthesia is recommended to strongly reduce the intraoperative use of the potent synthetic opioids. A judicious choice of the drugs used is also important. The development of tools allowing monitoring intraoperative nociception may help to reach these goals. Post-operative balanced analgesia and patient's education are mandatory. Transitional Pain Services may be necessary in some patients to prevent long-lasting and uncontrolled intake of opioids prescribed to treat postoperative pain. Among the opioids, some drugs have an important addictive effect (e.g. tramadol, oxycodone), specifically in predisposed patients (e.g. using other addictive substances like tobacco, alcohol, benzodiazepines). Optimising perioperative opioids use also includes the management of preoperative opioids intake (which may concern up to 25% of the patients scheduled for surgery). Preoperative opioids intake (even "weak" opioids) sensitises the central nervous system and negatively affect postoperative recovery.