Preoperative Management- FREE NO CME-Preoperative Management (720p HD)

Video Transcription

Video Summary

Dr. Ha (Stanford) outlines how to build a comprehensive perioperative pain plan starting with a thorough preoperative assessment. Key risk factors for persistent postsurgical pain and prolonged opioid use include younger age, female sex, pre-existing pain (at or away from the surgical site), psychological comorbidities (anxiety, depression, catastrophizing), smoking, obesity, and especially preoperative opioid use; certain surgeries (thoracic, breast, joint arthroplasty, spine) carry higher risk. Clinicians should review medical/psychiatric history, current analgesic regimens, prior surgical pain experiences, cognitive/social supports, and substance use (including alcohol). She reviews opioid misuse definitions and notes limitations of existing screening tools (e.g., PMQ, SOAPP, ORT, COMM), emphasizing that no single instrument replaces longitudinal clinician assessment. The TAPS tool may better identify substance use than routine EHR documentation.<br /><br />Patient/family education and shared decision-making can reduce opioid prescribing, anxiety, sedative needs, and length of stay; studies show fewer opioid tablets prescribed when patients choose within a recommended range. Prehabilitation, smoking cessation, and addressing heavy alcohol use may improve outcomes. Guidance includes generally continuing chronic opioids perioperatively (avoid abrupt tapering), planning multimodal analgesia, and special considerations for cannabinoids and medication-assisted treatment (methadone/buprenorphine).

Keywords

perioperative pain management

preoperative assessment

persistent postsurgical pain risk factors

prolonged opioid use

opioid misuse screening tools

TAPS substance use screening

patient education and shared decision-making

multimodal analgesia