Perioperative Pain Control in the Opioid-Dependent Patient: Just Bite the Bullet?

Purpose of Review: The opioid crisis in the USA makes it very likely that a large number of patients who are opioid-dependent will require surgical procedures. Perioperative pain control in those patients poses a formidable challenge to the surgical and anesthesia care team. Previously, patients received only additional opioids to cover the postoperative pain and would then be referred back to their primary care physician with often escalation of opioid dosing. Recent Findings: Various strategies and recommendations to help with postoperative pain control in these challenging situations are available and can be applied successfully in various ambulatory and hospital settings. Summary: Opioid-dependent patients presenting for surgery will challenge a health care system to provide optimal patient care, requiring close communication among the surgical team, anesthesiologists, referring physicians, and pain specialists. Regional anesthesia and multimodal analgesia are best suited to reduce or possibly avoid opioids altogether. Surgery location and monitoring may need to be adapted from standard care according to the chronic pain therapy and the presence of opioid use disorder (OUD). The preoperative visit is the most important time with the patient to set goals and expectations as well as developing a strategy for perioperative pain control.