Table 2: Summary of perioperative prevention strategies for opioid abuse.

PreoperativeReference

Risk factors assessment
Substance use disorder (opioids, alcohol, tobacco and others)[24, 5052] [29, 49, 54]
Previous or current opioid use (>50 oral morphine equivalents)[29]
Long-acting/extended release opioid formulations[29]
Use of benzodiazepines and other sedatives or history of mental illness[20]
Arthritis, depression, diabetes, heart failure, and lung disease[21, 34, 54, 66]
Low income or living in less developed areas[21, 35]
Prescription drug monitoring program for multiple opioid prescriptions or other agents[29]
Suggestions
Utilization of ERAS[71]
Cessation of smoking[72]
Education of patients and their families regarding the opioid-related risks, with more consultation service[73, 74, 75]
Treatment of the primary disease, such as arthritis, depression, and mental illness[76]
Presetting of acceptable postoperative pain level to reduce panic and tension[29]
Detailed and well-planed surgical approach[77]
Intraoperative
Meticulous surgical procedures that minimize nerve damage[78]
Advanced intraoperative monitoring[79, 80]
Combination of several anesthesia methods and analgesic drugs[81, 82, 83, 84]
Utilization of ERAS[71]
Postoperative
Implementation of educational programs and clinical guidelines on opioid use[73, 74, 75]
Utilization of REAS[71]
Nerve block technique or epidural blockade for postoperative analgesia[85, 86]
Decreased use of opioids and increased use of nonopioid medications for postoperative analgesic, including NSAIDs or opioid substitutes[81, 82, 8789]
Use of naloxone when needed[90]
Treatment of primary disease itself especially in patients with mental illnesses[76]
Relaxation and minimization of anxiety[91]