A Conversation with ASRA about Analgesic Drug Shortages

By Edward R. Mariano, MD, MAS (Clinical Research)    Apr 2, 2018

The crisis of prescription opioid overuse and abuse has affected countries around the world, and anesthesiologists are well-positioned to make positive changes.[1] Even minor outpatient surgical procedures, and their associated anesthesia and analgesia techniques, can lead to long-term opioid use.[2,3] Patients who present for surgery with an active opioid prescription are very likely to still be on opioids after a year.[4]


The new crisis of drug shortages threatens to reverse the many advances in perioperative pain control that have been achieved.


Anesthesiologists have been working to set up regional anesthesiology and acute pain medicine programs with careful coordination of inpatient and outpatient pain management to improve patient outcomes. Regional anesthesia, especially with continuous peripheral nerve block (CPNB) techniques, has been shown repeatedly to reduce patients’ need for opioid analgesia.[5]

Today, the new crisis of drug shortages threatens to reverse the many advances in perioperative pain control that have been achieved. Local anesthetics or “numbing medications” represent a class of drugs that is our strongest weapon against opioids. These drugs (e.g., bupivacaine, lidocaine, ropivacaine) are currently in shortage. Targeted injections of local anesthetic in the form of regional anesthesia eliminate sensation at the site of surgery and can obviate the need for injectable opioids (e.g., fentanyl, hydromorphone, morphine) which also happen to be in short supply.

The following are potential ramifications of the current drug shortages affecting anesthesia and pain management on patient care:

· Decreased quality of perioperative pain management

· Increased incidence of postoperative complications

· Increased health care costs

ASRA invites you to join us at the 2018 World Congress on Regional Anesthesia and Pain Medicine in New York City to have an open conversation about analgesic drug shortages. There is no specific agenda, and there will be no didactic presentation. Just come, share your stories, and work with us to figure out a path forward together.

Moderator: Edward R. Mariano, MD, MAS

Date: Saturday, April 21, 2018

Time: 11:30 am - 1 pm (Eastern)

Location: O’Neill Meeting Room, 4th floor, New York Marriott Marquis

References

  1. Alam A, Juurlink DN. The prescription opioid epidemic: an overview for anesthesiologists. Can J Anaesth 2016;63:61-8.
  2. Sun EC, Darnall BD, Baker LC, Mackey S. Incidence of and Risk Factors for Chronic Opioid Use Among Opioid-Naive Patients in the Postoperative Period. JAMA internal medicine 2016;176:1286-93.
  3. Rozet I, Nishio I, Robbertze R, Rotter D, Chansky H, Hernandez AV. Prolonged opioid use after knee arthroscopy in military veterans. Anesth Analg 2014;119:454-9.
  4. Mudumbai SC, Oliva EM, Lewis ET, Trafton J, Posner D, Mariano ER, Stafford RS, Wagner T, Clark JD. Time-to-Cessation of Postoperative Opioids: A Population-Level Analysis of the Veterans Affairs Health Care System. Pain Med 2016;17:1732-43.
  5. Richman JM, Liu SS, Courpas G, Wong R, Rowlingson AJ, McGready J, Cohen SR, Wu CL. Does continuous peripheral nerve block provide superior pain control to opioids? A meta-analysis. Anesth Analg 2006;102:248-57.

Edward R. Mariano, MD, MAS (Clinical Research) is the chief of the Anesthesiology and Perioperative Care Service and associate chief of staff for inpatient surgical services at VA Palo Alto Health Care System and a professor of anesthesiology, perioperative, and pain medicine at Stanford University School of Medicine.


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