Anesthesiologists should play bigger role in perioperative care of people with Substance Use Disorders

Newswise — August 24, 2023 – As use and misuse of alcohol, opioids, and psychostimulants continues to increase, anesthesiologists can become a more integral part of the care team managing patients with a Substance Use Disorder (SUD), according to a series of three articles published in the September issue of Anesthesia & Analgesia, the official journal of the International Anesthesia Research Society. The journal is published in the Lippincott portfolio by Wolters Kluwer.

The articles provide an overview of SUDs specific to the anesthesiologist and offer insights into pain management for opioid use disorder and exposure to psychostimulants. “The series is timely because the fundamental philosophies that guide management of patients with SUDs have evolved rapidly over the past decade. How can anesthesiologists begin to more adequately address the unmet needs of patients with SUDs in the perioperative period?” ask Akash Goel, MD, MPH, Department of Anesthesiology and Pain Medicine, University of Toronto, and Wiplove Lamba, MD, Department of Psychiatry University of Toronto, in an editorial overview of the series.

Recommendations for expanded involvement in managing patients with SUDs

As management of SUDs has evolved, anesthesiologists have become increasingly recognized as necessary to that management. The series ask readers to look at SUDs and SUDs treatment through the lens of a wide range of biopsychosocial factors and encourages a broader approach to effective disease management. For example, one article points out how discontinuing buprenorphine, a commonly used analgesic for reducing cravings, may actually increase opioid use during the perioperative period.

Goel and Lamba offer recommendations for how anesthesiologists can contribute meaningfully to improving outcomes for patients with a SUD. Trauma-informed patient care is critical. For example, during the pre-operative period understanding through direct discussion with a patient how their previous traumatic experiences might inform their perioperative experience and the need for a personalized pain management plan. Increased collaboration with patients, experts in Addiction Medicine and Psychiatry, patient advocacy groups, primary care providers, and other care partners is also key. In addition, with advances in treatment and the growing importance of socio-demographic factors, educational assets for anesthesiologists should be updated with content specific to addiction. Finally, the authors urge anesthesiologists to start viewing their role as one beyond pain management. Greater involvement in harm reduction interventions and surgical rehabilitation are two suggested areas.

Need for outcomes measurement to assess new approaches

The continuing evolution of both our understanding of addiction and substance abuse, and SUD management make high-quality studies and randomized controlled trials challenging. Objectives of these new approaches are to prevent relapse, reduce harm, minimize pain, and improve the overall well-being of people with SUDs. Goel and Lamba are proposing a system where relevant decision makers (patients, substance use experts) and appropriate stakeholders are involved in the policies and decisions that affect persons with SUDs.

Read the Substance Use Disorders issue of Anesthesia & Analgesia.

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About Anesthesia & Analgesia

Anesthesia & Analgesia is the official journal of the International Anesthesia Research Society. The journal provides the practice-oriented, clinical research needed to keep current and provide optimal care to patients. Each monthly issue includes peer reviewed articles on the latest advances in drugs, preoperative preparation, patient monitoring, pain management, pathophysiology, and many other timely topics.

About the International Anesthesia Research Society

The International Anesthesia Research Society is a nonpolitical, not-for-profit medical society founded in 1922 to advance and support scientific research and education related to anesthesia, and to improve patient care through basic research. The IARS contributes more than $1 million annually to fund anesthesia research; provides a forum for anesthesiology leaders to share information and ideas; maintains a worldwide membership of physicians, physician residents, and others with doctoral degrees, as well as health professionals in anesthesia-related practice; sponsors the SmartTots initiative in partnership with the FDA; and publishes the monthly journal Anesthesia & Analgesia and its companion journal, A&A Practice, semi-monthly.

About Wolters Kluwer

Wolters Kluwer (EURONEXT: WKL) is a global leader in professional information, software solutions, and services for the healthcare, tax and accounting, financial and corporate compliance, legal and regulatory, and corporate performance and ESG sectors. We help our customers make critical decisions every day by providing expert solutions that combine deep domain knowledge with specialized technology and services.

 Wolters Kluwer reported 2022 annual revenues of €5.5 billion. The group serves customers in over 180 countries, maintains operations in over 40 countries, and employs approximately 20,900 people worldwide. The company is headquartered in Alphen aan den Rijn, the Netherlands.

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