The Effectiveness of Intraoperative Pharmacologic Opioid Minimization Strategies on Postoperative Patient-Centred Outcomes

Abstract

For close to a century, opioid administration has been a standard of care to complement anesthesia during surgery. Considering the worldwide opioid epidemic, this practice is now being challenged and opioid alternatives are being used (eg. opioid minimizing strategies). As such, there is a need to generate evidence on the effectiveness and safety of opioid alternatives with a focus on outcomes that are the most meaningful to patients (ie. patient-centred). My proposed research program, called Optimizing Patient-centred outcomes Using opioid minimization Strategies (OPUS), directly addresses this evidence and knowledge gap while focusing on four of the top ten perioperative research priories in Canada (i.e. impact of reducing opioids during anesthesia, pain control after surgery, how can patient-centred outcomes be improved, and long-term side effects of anesthesia). The ultimate objective of OPUS is to assess the effectiveness of promising intraoperative pharmacologic opioid alternative (opioid minimizing) strategies through pragmatic clincal trials. My thesis represents foundational studies needed to meet this objective. I have 1) synthesized evidence from clinical trials assessing the patient-centred effectiveness of pharmacologic intraoperative opioid minimization strategies in adult surgical patients, and assessed the effectiveness of a promising opioid minimization pharmacologic strategy, 2) assessed Canadian anesthesiologists' opinions on intraoperative opioid minimizing practices used in adult surgical patients, and 3) designed a pilot multicentre pragmatic RCT to assess the feasibility of conducting a large trial in Canada to improve patient-centred outcomes among adult surgical patients.