ANESTHESIOLOGY 2022
The annual meeting of the American Society of Anesthesiologists was held from Oct. 22 to 25 in New Orleans and attracted approximately 15,000 participants from around the world, including anesthesiologists and other health care professionals. The conference featured presentations focusing on the latest advances in the relief of pain and total care of surgical patients prior to, during, and after surgery.
In one study, Naheed Jivraj, M.B.B.S., of the University of Toronto, and colleagues found that the total doses of postoperative opioids prescribed to older adults have decreased, despite the overall number of prescriptions remaining the same.
The authors evaluated 278,366 older adults undergoing surgery in Ontario, Canada, between 2013 and 2019, and assessed prescriptions filled for both nonopioids, such as nonsteroidal anti-inflammatory drugs (NSAIDs) or acetaminophen, and opioids within the first seven days after surgery. The researchers found that the percentage of patients filling prescriptions for both opioid and nonopioid analgesics after surgery remained unchanged during the study period; however, there was a reduction in the total dose of opioid prescribed across all procedures. The investigators also identified a change in the way opioids were prescribed, demonstrating a shift away from filling prescriptions for combination opioid tablets (oxycodone/acetaminophen) toward two separate prescriptions (one opioid and one nonopioid).
“The proportion of postoperative patients who fill prescriptions for nonopioid or opioid analgesics has remained stable. However, there is a shift away from combination medications towards separate prescriptions for opioids and nonopioids,” Jivraj said. “Patients undergoing procedures associated with low postoperative pain, such as appendectomy and thyroidectomy, may be comfortably treated with opioid-free techniques. In our study, few patients undergoing these low pain procedures filled prescriptions for acetaminophen or NSAIDs.”
In another study, Sunitha Singh, M.D., of Stony Brook Medicine in New York, and colleagues found that Enhanced Recovery After Surgery (ERAS) pathways can be leveraged to quickly respond to health care emergencies, while efficiently providing — and in some aspects improving — the delivery of care.
Within their hospital system, the authors implemented an ERAS program for elective hip and knee replacement surgeries that required at least an overnight hospital stay. During the COVID-19 pandemic, however, the hospital adjusted the protocol so that select patients could undergo outpatient procedures. The researchers found that the ERAS pathway, used in properly selected patients, allowed for outpatient surgery without the patient spending the night in the hospital.
The authors concluded that for many patients, same-day joint replacement is a safe alternative to an extended hospital stay. Same-day joint replacement minimizes the time patients spend in the hospital and reduces hospital resources, and it did not appear to lead to readmissions. In addition, patients were often more satisfied when recovering comfortably at home.
“The success of our ERAS pathway stems from multidisciplinary stakeholder engagement. Surgeons, anesthesiologists, nurses, physical/occupational therapists, social workers, dieticians, and information technology are just some of the services involved in developing and implementing the best strategies for patient care,” Singh said. “The patient and caretaker are also an integral part of the team and vital to successful pathway completion.”
Padma Gulur, M.D., of Duke Anesthesiology and Duke Health in Chapel Hill, North Carolina, and colleagues found that wearing eyeglasses that filter a certain wavelength on the green light spectrum seems to reduce pain-related anxiety and the need for opioids to manage chronic pain in patients with fibromyalgia.
The authors randomly assigned 34 patients with fibromyalgia to wear various shades of eyeglasses four hours a day for two weeks. Ten patients wore blue eyeglasses, 12 wore clear eyeglasses, and 12 wore green eyeglasses. The researchers found that the patients who wore green eyeglasses experienced reduced anxiety compared with patients who wore other shades of glasses, who saw no reduction in anxiety. In addition, patients who wore green eyeglasses used fewer opioid drugs.
“Green light-based therapy using specialized eyeglasses results in reduction of pain-related fear and anxiety,” Gulur said.
ASA: Preoperative Cannabis Use Tied to Higher Pain After Surgery
TUESDAY, Nov. 1, 2022 (HealthDay News) — While presurgical cannabis use is not associated with postoperative opioid use, it is significantly associated with time-weighted average pain scores in the first 24 hours, according to a study presented at the annual meeting of the American Society of Anesthesiologists, held from Oct. 22 to 25 in New Orleans.
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ASA: Same-Day Hip, Knee Replacement Feasible for Selected Patients
TUESDAY, Nov. 1, 2022 (HealthDay News) — Despite the pandemic and same-day admission limitations, effective multidisciplinary collaborations within Enhanced Recovery After Surgery pathways can improve services and provide continuity of care for total joint replacements, according to a study presented at the annual meeting of the American Society of Anesthesiologists, held from Oct. 22 to 25 in New Orleans.
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ASA: Green Light Therapy for Pain-Related Anxiety Studied in Fibromyalgia
TUESDAY, Nov. 1, 2022 (HealthDay News) — Green light therapy might decrease anxiety, particularly fear-based anxiety, in patients with fibromyalgia and reduce the use of opioids to manage chronic pain, according to a study presented at the annual meeting of the American Society of Anesthesiologists, held from Oct. 22 to 25 in New Orleans.
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ASA: Less Noise May Aid Children’s Behavior Following General Anesthesia
MONDAY, Oct. 31, 2022 (HealthDay News) — A reduced noise environment in the operating room may improve postoperative behavior in children undergoing general anesthesia, according to a study presented at the annual meeting of the American Society of Anesthesiologists, held from Oct. 22 to 25 in New Orleans.
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