Caring for Patients with Substance Use Disorders in the Perioperative Space- FREE NO CME-Caring for Patients with Substance Use Disorders in the Perioperative Space

Video Transcription

Video Summary

This Lunch and Learn focuses on perioperative care for patients with substance use disorders (SUD), emphasizing that SUD is a chronic, treatable condition distinct from physical dependence. The presenter highlights that unhealthy substance use is common even in elective surgery (about 2 in 5 patients) and is linked to worse surgical outcomes (e.g., tobacco-related wound complications, alcohol-related mortality risk, cocaine–anesthesia issues, opioid tolerance/respiratory risk, and emerging cannabis considerations).<br /><br />Key recommendations include using validated screening tools (e.g., TAPS, AUDIT-C, DAST-10) and asking nonjudgmental, trust-building questions to reduce under-reporting. Preoperative planning should assess withdrawal risk, coordinate with anesthesia, and involve pain/addiction specialists when needed. Intra- and postoperative care should prioritize multimodal, non-opioid and regional/neuraxial analgesia, monitor and treat withdrawal (e.g., CIWA protocols for alcohol), and ensure careful discharge planning with patient-specific opioid prescribing, safe storage/disposal counseling, and naloxone co-prescribing when opioids are used.<br /><br />Case examples address managing a patient on buprenorphine (often continuing and splitting dosing for analgesia) and a patient with heavy alcohol use needing emergent surgery. The session also covers ethical/legal issues (shared decision-making, equity, confidentiality/42 CFR) and stigma reduction through person-first language.

Keywords

perioperative care

substance use disorders (SUD)

preoperative screening tools (TAPS, AUDIT-C, DAST-10)

multimodal non-opioid analgesia

regional/neuraxial anesthesia

withdrawal monitoring and CIWA protocol

buprenorphine perioperative management

opioid prescribing with naloxone co-prescribing