b'Multimodal Use of Non-Opioid Painkillers Urged for Post-Surgical Patientsu From Page 14Source: The American Journal of Surgery DOI: (10.1016/j.amjsurg.2019.06.022)forVHAPainManagementpointedinternationalreviewearlierthisyearpersistentpost-operativeuse,while out that the approach to acute and post- in Frontiers of Surgery discussed thealso contributing to an increased risk surgical pain has been changing in theopioid crisis and the role played by sur- of several other adverse clinical out-healthcare system. Opioids may not begeons, pointing out, Over the past twocomes, the authors wrote.the most effective or safest approach indecades, there has been a sharp rise in many situations, and when opioids arethe use of prescription opioids. In sev- n on - opioida nalgesicsusedtheyshouldbeprescribedattheeral countries, most notably the UnitedAmericanSocietyofAnesthesiology lowest effective dose and for the short- States,opioid-relatedharmhasbeenguidelines strongly urge that, whenever estindicatedduration,accordingtodeemed a public health crisis. As sur- possible,anesthesiologistsshoulduse theadviceforproviders.Evenwhengeons are among the most prolific pre- multimodalpainmanagementtherapy, opioids are used short term, the risks ofscribers of opioids, growing attention isincludingmedicationssuchasacet-short-term therapy becoming long-termnow being paid to the role that opioidsaminophenCOX-2selectiveNSAIDs, therapy increases with longer durationplay in surgical care. 2 or COXIBs, nonselective NSAIDs, and andhigherdosesofopioidtherapy.Thearticlecalledforgreaterscru- calcium channel -2- antagonists such Current guidelines and recent evidencetiny of pain management prescribingas gabapentin and pregabalin should be recommendmultimodaltreatmentofpractices,whilealsoconcedingthatconsideredaspartofapost-operative acutepainanduseofnon-pharmaco- opioidsmightsometimesbeneces- multimodal pain management regimen. 3logicoptionsandnon-opioidpharma- sary to provide patients with adequateThose can be combined with regional cologic options as first-line therapy withrelief from acute pain after major sur- blockadewithlocalanesthetics,the opioids added when necessary. gery. We draw attention to the mount- ASA noted.In an effort to implement the changes,ing evidence that preoperative opioidRecently,theFoodandDrug the spotlight has been on surgeons. AnexposureplacespatientsatriskofAdministrationapprovedAnjeso 2020 COMPENDIUM OF FEDERAL MEDICINE 19'