Article Text

Download PDFPDF

228 Opioid sparing anaesthesia and analgesia techniques; a quality improvement project
  1. D Liotiri,
  2. N Attaway,
  3. S Soobhug and
  4. W Caddye
  1. Brighton and Sussex University Hospitals NHS Trust, Brighton, UK


Background and Aims Overreliance on opioids to treat postoperative pain and increased availability of opioids in the community have contributed to the opioid epidemic (1). For many patients, the source of initial exposure to opioids is the perioperative period. The aim of this project was to identify local practice and introduce ways to minimise opioids during anaesthesia and recovery.

Methods We conducted a two-week snapshot audit in November 2019 at Brighton and Sussex University Hospitals (BSUH) (UK). The audit was registered with BSUH anaesthetic department Audit and Quality Improvement. Ethics approval was not required. We collected data on opioid use in four theatres and recovery. We also conducted a literature search to identify best available evidence on non-opioid adjuncts.

Results Median opioid use in each theatre and recovery are presented in table 1. In recovery, 1 in 3 patients required more than 10 mg intravenous morphine equivalents (IVME), and more than 1 in 10 patients received more than 20 mg IVME. We compiled evidence-based opioid sparing anaesthesia and analgesia guides for use in theatres and recovery (Figure 1).

Abstract 228 Table 1

Opioid use in theatres and recovery during the first two weeks of November 2019. IVME=IV morphine equivalents, n=number of patients, median=median opioid use, PACU=post anaesthesia care unit

Conclusions Although there are no standards to compare with, we believe that these results indicate high opioid use during anaesthesia and recovery. The risk of opioid dependence and side effects that may adversely affect surgical outcomes should be taken into account before prescribing opioids. There is a plethora of non-opioid adjuncts which may facilitate opioid-free or opioid-light anaesthesia and analgesia. Further work is required to investigate if anaesthesia and recovery opioid sparing protocols can improve patient outcomes.

Statistics from

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.