Opioid Stewardship

Question 1

Opioid Stewardship: Before Admission

Answer 1

• Identify patients on high-dose opioids
• Identify patients at risk of persistent post-op opioid use
• Consider supervised weaning
• Set expectations

Question 2

Opioid Stewardship: During Surgery

Answer 2

• Opioid-sparing multi-modal analgesia: dexamethasone, lidocaine, ketamine, magnesium
• Regional anaesthesia where possible

Question 3

Opioid Stewardship: Ward Care

Answer 3

• Oral opioids only where possible
• PRN immediate release opioids only and titrate to effect
• Avoid co-sedatives
• Sedation scoring
• Multimodal analgesia

Question 4

Opioid Stewardship: Prepare for Discharge

Answer 4

• Identify patients requiring additional opioid-weaning support
• Written and verbal info on safe analgesia management
• Discharge analgesia: non-opioids, short course immediate release opioids only (7 day max), no modified release preps

Question 5

Opioid Stewardship: After Discharge

Answer 5

• Opioid use only to facilitate function
• Wean using the reverse pain ladder
• Refer to pain team if still using opioids 3 months post-op
• Avoid driving