You are here

  • Home
  • Online First
  • Alcohol use disorder in the perioperative period: a summary and recommendations for anesthesiologists and pain physicians

Article Text

Article menu

other Versions

Download PDFPDF
Education
Alcohol use disorder in the perioperative period: a summary and recommendations for anesthesiologists and pain physicians
  1. Olabisi Lane1,
  2. Vats Ambai1,
  3. Arjun Bakshi1 and
  4. Sudheer Potru2
  1. 1Anesthesiology, Emory University School of Medicine, Atlanta, Georgia, USA
  2. 2Atlanta VA Medical Center, Emory University School of Medicine, Atlanta, Georgia, USA
  1. Correspondence to Dr Olabisi Lane, Anesthesiology, Emory University School of Medicine, Atlanta, GA 30308, USA; olabisi.lane{at}emory.edu

Abstract

Excessive alcohol consumption and alcohol use disorder (AUD) increase the risk of perioperative morbidity and mortality. Aspiration, malnutrition, coagulopathies, seizures, and hemodynamic alterations are only a few of the major concerns related to acute alcohol intoxication and AUD. There are also numerous physiological effects, changes in medication metabolism and pharmacology, and adverse events related to chronic alcohol consumption. These are all important considerations for the anesthesiologist in the perioperative management of a patient with AUD. Pain perception and thresholds are altered in patients with acute and chronic alcohol use. Medications used to manage AUD symptoms, particularly naltrexone, can have significant perioperative implications. Patients on naltrexone who continue or stop this medication in the perioperative period are at an increased risk for undertreated pain or substance use relapse. This review highlights key considerations for the anesthesiologist and pain physician in the perioperative management of patients with active AUD (or those in recovery). It discusses the effects of acute and chronic alcohol use on pain perception and thresholds, provides guidance on the perioperative management of naltrexone and low-dose naltrexone, and reviews a multimodal approach to pain management.

  • analgesia
  • Pain, Postoperative
  • Postoperative Complications
  • EDUCATION
  • Pain Management

Data availability statement

No data are available. Not applicable.

https://doi.org/10.1136/rapm-2023-104354

Statistics from Altmetric.com

    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.

    Data availability statement

    No data are available. Not applicable.

    View Full Text

    Footnotes

    • Twitter @BisiLaneMD, @SPotruDO

    • Contributors OL: authored introduction, along with sections central and peripheral nervous system, cardiovascular, respiratory, GI systems, perioperative considerations, pain perception, pain threshold, low dose naltrexone. VA: authored introduction, GI, cirrhosis and coagulopathy, seizures, and perioperative naltrexone management. AB: authored abstract along with sections on pharmacology of alcohol, pathophysiology of withdrawal. SP: senior author, authored sections on preoperative evaluation, comorbid SUDs, FDA-approved treatments, pain control, and perioperative naltrexone management, pain perception, pain threshold.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests None declared.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Author note *Citations 81-108 are referenced in supplemental figures and tables.

    • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.