Surgical & Healthcare Alliance for enhanced Recovery & Pain Management (SHARP) Six Part Mini-Lecture Series-FREE NO CME-Perioperative Care & Special Considerations (1080p HD)

Video Transcription

Video Summary

Dr. Jennifer Ha reviews goals and special considerations for preoperative assessment to optimize perioperative pain control. Key aims are to identify patients at risk for difficult postoperative pain (chronic pain, substance use disorder, mood disorders/pain catastrophizing, chronic opioid therapy) and to address modifiable factors early with an individualized plan. Assessment should include medical and psychiatric comorbidities, current medications (opioids, sedatives, psychotropics), procedure-related risks, and contraindications to multimodal/regional techniques. Because many adults have opioid use disorder risk factors, planning should also anticipate opioid-related adverse events.<br /><br />Preoperative patient/family education reduces anxiety and improves outcomes by setting expectations for anesthesia/surgery, pain control, rehabilitation, diet, and recovery timelines. Education emphasizes functional goals, “manageable” rather than zero pain, opioid risks, multimodal alternatives, and clear opioid-prescribing handoffs after discharge. Brief psychological preparation (relaxation/CBT concepts) and, when feasible, prehabilitation may reduce complications and opioid use. Smoking cessation (even 24–48 hours) and addressing heavy alcohol use are highlighted.<br /><br />Special cases include chronic opioid therapy (continue baseline to avoid withdrawal; avoid rapid taper; coordinate with prescribers; check PDMP), cannabinoid use (encourage 72-hour abstinence; watch for withdrawal and anesthetic implications), and medications for addiction treatment. Methadone should be continued, often split for analgesia, with QT-risk awareness. Buprenorphine is usually continued with dose-splitting and adjuncts. Naltrexone requires preop discontinuation and careful postoperative reinitiation planning.

Keywords

preoperative pain assessment

perioperative pain management

multimodal analgesia

opioid use disorder risk

chronic opioid therapy

buprenorphine methadone naltrexone management

patient education and expectation setting