Intended for healthcare professionals

Editorials

Prolonged use of opioids after surgery

BMJ 2014; 348 doi: https://doi.org/10.1136/bmj.g1280 (Published 11 February 2014) Cite this as: BMJ 2014;348:g1280

Re: Prolonged use of opioids after surgery

As anaesthetists we too often judge our success using short & ultra-short outcome measures: we therefore welcome this new data, not only as a novel source, but also for providing a long term perspective on the quality of our patient care.

Since the 1950s Gray's Triad of hypnosis, muscle relaxation and reflex suppression (analgesia) has proved an enduring model for balanced anaesthesia. Even when taking a multimodal approach to analgesia we very commonly (almost invariably) include a potent opioid in the anaesthetic cocktail. Opioids act as powerful reflex suppressors - reducing the unconscious responses (including potentially dangerous hypertensive responses) to intubation and surgery. Fentanyl in particular acts rapidly and reliably, and promotes smooth and controlled anaesthesia: we see it as improving the quality of care. This work, by allowing us to reflect on longer term outcomes, shows us that something we have long thought serves the patient well, may in fact cause harm to some. Perhaps the time has come to look again at how we deliver reflex suppression - or even at the standard model itself.

We cannot simply accept that 3% of our major surgery patients appear to become dependent on opioid medications - we must act with our colleagues in surgery & general practice to better understand & address this problem.

Competing interests: No competing interests

11 March 2014
Paul Maguire
CT1
Mark Davies
Dept. of Anaesthesia, Royal Liverpool & Broadgreen University Hospitals NHS Trust
Liverpool L7 8XP UK