The American Society of Anesthesiologists (ASA) and 14 major medical specialty organizations have established seven guiding principles to best address the perioperative management of acute pain in complex surgical patients. The principles were established at a historic Pain Summit, the second of its kind, hosted by the ASA.
Every surgical patient deserves adequate pain relief that aims to prevent opioid addiction, chronic pain, and other negative outcomes, but achieving this may be more difficult in certain patient populations. The new principles have been created to build on an original set established last year at our first Pain Summit, but are aimed specifically at patients undergoing surgery with chronic pain, those taking opioids before surgery and to those with substance use disorders. The new principles give the perioperative care team more guidance in caring for these particularly complex patients.”
Randall M. Clark, MD, FASA, ASA President
In February 2021, the ASA convened 14 medical specialty organizations for a Virtual Pain Summit to collaborate on a resource for acute surgical pain care. Participating organizations reached consensus on seven fundamental principles of perioperative management of acute pain, published in Regional anesthesia and pain medicine. To build on the best practices and knowledge shared at the first pain summit, a second virtual summit was held on February 26, 2022 to establish guiding principles for treating complex surgical patients.
The seven new principles, which will be developed into a resource for clinicians and other members of the healthcare team, recommend:
- If clinicians identify a positive screen for substance use pre-operatively, a more detailed assessment tool should be used to stratify patients’ risks for further support or referral for treatment, as appropriate.
- During a preoperative assessment, if a patient is identified as having chronic pain, opioid tolerance, or a substance use disorder, clinicians should coordinate with the patient’s care team, including including consultation with a specialist in pain medicine, behavioral health or addiction.
- For patients on long-term opioid therapy preoperatively, clinicians should coordinate with the patient’s prescribing clinician and continue the baseline opioid dose during the perioperative period with supplemental analgesia as needed for acute postoperative pain.
- Clinicians should work with patients who have opioid tolerance on an individualized postoperative opioid reduction plan, in coordination with the clinician prescribing long-term opioids, with the goal of returning to or below the preoperative dose as soon as possible.
- For patients who were prescribed opioids at discharge from surgery, clinicians should educate them and their caregivers about the risks, signs, and management of opioid-induced respiratory depression; that they should avoid the concomitant consumption of drugs with a sedative effect and alcohol when taking opioids; and when to call for emergency help.
- For patients identified as being at significant risk for opioid-related adverse events or severe uncontrolled perioperative pain, clinicians should consult with a pain specialist or anesthetist before surgery.
- For patients identified as benefiting from an additional consultation with a pain medicine, behavioral health, or addictions specialist, clinicians should use telehealth options if in-person consultation is not available.
In addition to the ASA, participating medical organizations include:
- American Academy of Orthopedic Surgeons
- American Academy of Otolaryngology-Head and Neck Surgery
- American Association of Neurological Surgeons
- American Association of Oral and Maxillofacial Surgeons
- American College of Obstetricians and Gynecologists
- American College of Surgeons
- American Hospital Association
- American Medical Association
- American Society for Addiction Medicine
- American Society of Breast Surgeons
- American Society of Plastic Surgeons
- American Society of Regional Anesthesia and Pain Medicine
- American Urological Association
- Society of Thoracic Surgeons
“The next step for this consortium and multi-company effort is to establish how we can help institutions implement both sets of guiding principles into their practices,” Dr. Clark said.
American Society of Anesthesiologists