Eras Protocol Options For Perioperative Pain Management Of Substance Use Disorder In The Ambulatory Surgical Setting

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Current Pain and Headache Reports


Abstract: Even prior to the COVID-19 pandemic, rates of ambulatory surgeries and ambulatory patients presenting with substance use disorder were increasing, and the end of lockdown has further catalyzed the increasing rates of ambulatory patients presenting for surgery with substance use disorder (SUD). Certain subspecialty groups of ambulatory procedures have already established protocols to optimize early recovery after surgery (ERAS), and these groups have subsequently enjoyed improved efficiency and reduced adverse outcomes as a result. In this present investigation, we review the literature as it relates to substance use disorder patients, with a particular focus on pharmacokinetic and pharmacodynamic profiles, and their resulting impact on the acute- or chronic user ambulatory patient. The systematic literature review findings are organized and summarized. We conclude by identifying areas of opportunity for further study, specifically with the aim of developing a dedicated ERAS protocol for substance use disorder patients in the ambulatory surgery setting. Key Summary Points: - Healthcare in the USA has seen an increase in rates of both substanceuse disorder patients and separately in ambulatory surgery cases. - Specific perioperative protocols to optimize outcomes for patients whosuffer from substance use disorder have been described in recent years. - Agents of interest like opioids, cannabis, and amphetamines are thetop three most abused substances in North America. - A protocol and recommend further work should be done to integrate withconcrete clinical data, in which strategies should be employed to conferbenefits to patient outcomes and hospital quality metrics like those enjoyed byERAS protocol in other settings.

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