Journal of opioid management最新文献

{"title":"The critical role of maxillofacial surgeons in pain prevention and opioid consumption reduction.","authors":"Ricardo Grillo, Bruno Alvarez Quinta Reis, Isabela Romão Cândido, Alexandre Meireles Borba, Michael Miloro, Fernando Melhem-Elias","doi":"10.5055/jom.0984","DOIUrl":"10.5055/jom.0984","url":null,"abstract":"<p><strong>Objectives: </strong>Managing pain in oral and maxillofacial surgery (OMS) poses significant challenges due to the intricate nature of the procedures and extensive tissue manipulation. While opioids are often utilized for their strong analgesic effects, they carry serious risks, including a high potential for addiction and overdose-related fatalities. This paper aims to conduct a comprehensive literature review to explore effective, opioid-sparing pain management strategies in OMS, with a specific focus on evidence-based techniques that reduce reliance on opioids.</p><p><strong>Methods: </strong>A comprehensive literature review was conducted using PubMed, Web of Science, and Google Scholar databases, primarily focusing on the last 5 years (2019-2024) to ensure updated information, though seminal older works were also considered. The inclusion criteria focused on studies reporting alternatives to opioids for pain and discomfort control after OMS. Narrative reviews, editorials, and articles without a digital object identifier were excluded. Relevant data from the selected articles were extracted and analyzed.</p><p><strong>Results: </strong>A total of 4,306 articles were assessed, with 102 included in the review. The procedures reviewed included orthognathic surgery, maxillofacial trauma, reconstruction, dento-alveolar surgery, temporomandibular joint procedures, cleft palate surgery, and severe odontogenic infections. Thematic analysis revealed that the central question was answered affirmatively: Nonopioid strategies are effective in reducing opioid consumption. These strategies were found to maintain post-operative pain control while minimizing complications like post-operative nausea and vomiting. This review synthesizes the evidence to provide a clear hierarchy of recommended interventions.</p><p><strong>Conclusion: </strong>This review consolidates evidence indicating that a combination of stringent prescribing practices, multimodal analgesia, and regional anesthetic techniques can significantly reduce opioid dependence. To prevent opioid overprescription, it is essential to enforce strict regulatory measures, closely monitor prescriptions, establish regional guidelines, and avoid just-in-case prescribing. Effective strategies for improving post-operative outcomes and reducing opioid dependence include multimodal and pre-emptive analgesia, as well as post--operative anesthetic blocks. The findings provide a consolidated evidence base to guide maxillofacial surgeons in implementing these strategies, directly addressing the opioid crisis within the specialty.</p>","PeriodicalId":16601,"journal":{"name":"Journal of opioid management","volume":"22 5","pages":"513-524"},"PeriodicalIF":0.0,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149181849","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Digital twins for personalized management of opioid use disorder: A future outlook.","authors":"Motahareh Soltani, Somayyeh Karami-Mohajeri, Abass Aghaei-Afshar, Zohreh Oghabian, Sakineh Khanamani Falahatipour, Soudeh Khanamani Falahati-Pour, Maryamosadat Mavaei, Amirreza Ghasemloo","doi":"10.5055/jom.0987","DOIUrl":"https://doi.org/10.5055/jom.0987","url":null,"abstract":"<p><strong>Introduction: </strong>The opioid crisis, affecting over 16 million individuals globally and causing approximately 450,000 deaths annually, underscores the urgent need for personalized treatment approaches for opioid use disorder (OUD). Current treatments, such as medication-assisted therapy, suffer from low retention rates and variable responses due to individual differences.</p><p><strong>Methods: </strong>This study proposes a digital twin framework, integrating genetic profiles, eg, OPRM1 variants, electronic health records, ecological momentary assessments, and real-time physiological data from wearables. Machine learning and pharmacokinetic modeling are employed to develop patient-specific models, with validation planned across short-term (2 years), medium-term (5 years), and long-term (10 years) phases. Proposed framework: The framework enables personalized dosing, relapse risk prediction, and tailored behavioral interventions by synthesizing multimodal data into dynamic virtual models. It leverages cloud-based platforms for scalability and complies with Health Insurance Portability and Accountability Act and General Data Protection Regulation for data privacy.</p><p><strong>Discussion: </strong>The framework addresses OUD treatment gaps by improving retention and reducing overdose risks, eg, 87,000 overdose deaths in the United States (US) in 2024. It supports public health by optimizing resource allocation for the 2 million prescription-related and 600,000 heroin-related OUD cases in the US. Challenges include data integration, clinical validation, and equitable access.</p><p><strong>Conclusion: </strong>Digital twins offer a transformative approach to OUD management, with future research needed to validate and integrate this technology into healthcare systems.</p>","PeriodicalId":16601,"journal":{"name":"Journal of opioid management","volume":"22 5","pages":"445-457"},"PeriodicalIF":0.0,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149182664","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Assessment of a standardized pain management protocol for adult patients with sickle cell disease.","authors":"Lindsey E Dayer, Issam Makhoul, Collin Montgomery, Leigh Ann Wilson, Sarah Council, Stella Bowers, Sarah E Harrington, Mrinmayee Lakkad, Suzanne Saccente, Jacob T Painter","doi":"10.5055/jom.1008","DOIUrl":"https://doi.org/10.5055/jom.1008","url":null,"abstract":"<p><strong>Objective: </strong>To evaluate the impact of a standardized pain management protocol on prescribing practices for opioids, nonopioid therapies, and disease-modifying agents among adult patients with sickle cell disease (SCD) in an outpatient setting.</p><p><strong>Design: </strong>A retrospective analysis comparing prescribing patterns before and after the implementation of a standardized pain management protocol.</p><p><strong>Setting: </strong>An adult sickle cell clinic at an academic medical center.</p><p><strong>Patients/participants: </strong>A total of 165 adult patients diagnosed with SCD receiving outpatient care.</p><p><strong>Interventions: </strong>Implementation of a multidisciplinary team-developed standardized pain management protocol for assessing and managing pain and psychological distress in patients with SCD.</p><p><strong>Main outcome measure(s): </strong>Changes in opioid prescribing patterns (including median morphine equivalent daily dose [MEDD]), prescribing of nonopioid therapies, eg, antidepressants, anticonvulsants, nonsteroidal anti-inflammatory drug (NSAIDs), prescribing of disease-modifying agents (hydroxyurea), and pain scores.</p><p><strong>Results: </strong>Following protocol implementation, the proportion of patients prescribed opioids decreased to 91.5 percent (p = 0.03). Although no significant change occurred in median MEDD, prescribing of nonopioid therapies significantly increased, including hydroxyurea (57.5 percent vs 21.2 percent, p < 0.01), antidepressants, anticonvulsants, and NSAIDs. Pain scores decreased slightly but not significantly.</p><p><strong>Conclusions: </strong>The standardized outpatient pain management protocol has the potential to reduce opioid usage and increase the adoption of evidence-based nonopioid therapies in patients with SCD. Further validation in diverse clinical settings is warranted to assess the protocol's long-term effectiveness and outcomes.</p>","PeriodicalId":16601,"journal":{"name":"Journal of opioid management","volume":"22 5","pages":"437-443"},"PeriodicalIF":0.0,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149182697","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"OUR crisis: Evolution of a third-year medical student opioid epidemic-themed inter-clerkship week to reflect the landscape of pain and addiction care.","authors":"Laura Harrison, Melissa Pawelczak, Mersema T Abate, Stephen Butkus, Sandeep Kapoor","doi":"10.5055/jom.1005","DOIUrl":"https://doi.org/10.5055/jom.1005","url":null,"abstract":"<p><strong>Objective: </strong>A week-long themed interclerkship curricular experience was designed to reframe THE Opioid Epidemic as \"OUR Opioid Epidemic,\" humanize and normalize opioid use disorder and pain, and motivate a shift in attitudes, knowledge, comfort, and perceived skills.</p><p><strong>Design: </strong>This was a prospective cohort study with pre- and post-curriculum surveys.</p><p><strong>Setting: </strong>The curriculum was delivered at a medical school associated with a large health system over 6 academic years.</p><p><strong>Participants: </strong>Third-year medical students who previously received \"Evidence-Based Screening Tools\" and \"Drug Use and the Brief Negotiated Interview\" sessions of the longitudinal, spiraling \"Addressing Substance Use\" curriculum.</p><p><strong>Interventions: </strong>Over 55 faculty/facilitators spanning 40 clinical/nonclinical departments developed and delivered the \"OUR Opioid Epidemic\" themed interclerkship experience. Annual iterations responded to learner and faculty feedback, the ever-changing landscape of substance use, and the evolution of pain care strategies. Learners participated in first-person perspective panels, large group sessions, workshops, and a culminating capstone experience.</p><p><strong>Main outcome measure(s): </strong>Pre- and post-session surveys assessed changes in knowledge, attitudes, comfort, and perceived skills.</p><p><strong>Results: </strong>The curriculum was highly rated by students and positively shifted attitudes, knowledge, comfort, and perceived skills around opioid use, pain care, and substance use disorder.</p><p><strong>Conclusions: </strong>The landscape of substance use and pain is complex and changing. Medical school curricula must thus evolve. Experiential workshops, perspectives of individuals with lived experience, student-developed elements, and a capstone session prepared students to thoughtfully address pain care and substance use. The week served to empower learners to model-up as they continue their professional formation in clinical settings.</p>","PeriodicalId":16601,"journal":{"name":"Journal of opioid management","volume":"22 5","pages":"467-486"},"PeriodicalIF":0.0,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149181471","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Global cannabis regulations: Current scenario and the way ahead.","authors":"Abhinav Kumar Singh, Vikesh Kumar Shukla, Navneet Sharma","doi":"10.5055/jom.0986","DOIUrl":"10.5055/jom.0986","url":null,"abstract":"<p><p>Cannabis sativa is commonly known as cannabis or marijuana. It is a psychoactive drug. It has been in use for thousands of years for its medicinal and recreational properties. This article explores the regulatory frameworks governing cannabis and similar drugs in the United States (US), India, and Australia, highlighting key differences, exclusions, inclusions, and their status. In the US, cannabis is federally illegal under the Controlled Substances Act, but numerous states have legalized its use for medical and recreational purposes, creating a patchwork of laws that vary widely across the country. In India, cannabis remains largely prohibited under the Narcotic Drugs and Psychotropic Substances Act, 1985, though certain traditional uses, such as bhang, are permitted, and there are emerging efforts to explore its medicinal potential. Australia has legalized medical cannabis at the federal level, while recreational use remains illegal, except for its decriminalization in the Australian Capital Territory. The Preferred Reporting Items for Systematic reviews and Meta-Analyses methodology has been adopted to make the review more efficient. This study identifies key factors influencing regulatory decisions, including public opinion, medical research, and economic considerations. The United Nations Single Convention on Narcotic Drugs (1961) poses a regulatory challenge by requiring member states to prohibit cannabis production, distribution, and use, thereby creating conflicts with national laws that have legalized or decriminalized cannabis, and hindering international cooperation, trade, and research. By addressing these factors, regulators can create effective frameworks that minimize harms and maximize benefits. Understanding these complex regulatory environments is crucial for policymakers, healthcare professionals, and industry members. This research contributes to informed discussions on harm reduction, public health, and human rights, ultimately informing evidence-based policy decisions and future directions.</p>","PeriodicalId":16601,"journal":{"name":"Journal of opioid management","volume":"22 5","pages":"525-540"},"PeriodicalIF":0.0,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149182621","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Impact of an addiction medicine consult service on medications for opioid use disorder initiation in hospitalized patients.","authors":"Madeline Dillen, Alexandria Taylor, Sanketh Proddutur, Joshua Shulman, Megan Baumgartner, Frank D'Amico","doi":"10.5055/jom.0934","DOIUrl":"10.5055/jom.0934","url":null,"abstract":"<p><strong>Objective: </strong>The number of overdose deaths rose by 60 percent between 2019 and 2021. Medications for opioid use disorder (MOUD) have been associated with reduced overdoses and opioid-related hospitalizations. Hospital addiction medicine consult services (AMCSs) have been shown to reduce all-cause 90-day mortality post-discharge. This study aimed to expand on the impact of AMCS on the initiation of MOUD in inpatients. Design, setting, patients/participants, interventions, main outcome measure: This study is a retrospective, single site, multicenter, cohort study conducted at two sites. Utilizing International Classification of Diseases, Tenth Revision codes related to opioid use disorder (OUD), inpatients older than 18 years who were not already on MOUD were assessed at two separate hospitals during two time periods each. Site 1 initiated an AMCS in 2021, while site 2 had no AMCS. Data for each site for each period were assessed at baseline and post-ACMS initiation, and we compared the change in MOUD initiation rates between these periods at site 1 and site 2.</p><p><strong>Results: </strong>A total of 504 patients were assessed. The rate of MOUD initiation at site 1 was 8 percent (10/126) for the baseline and 21 percent (26/126) for the post-period (difference in proportions = 0.13; 95 percent confidence interval [CI] 0.04-0.21; p = 0.004). The rate of MOUD initiation at site 2 was 5 percent (6/126) for the preperiod and 6 percent (8/126) for the post-period (difference in proportions = 0.016; 95 percent CI -0.04-0.075; p = 0.582).</p><p><strong>Conclusions: </strong>Availability of a hospital AMCS was associated with increased rates of MOUD initiation in inpatients with a history of OUD not on MOUD.</p>","PeriodicalId":16601,"journal":{"name":"Journal of opioid management","volume":"22 5","pages":"499-503"},"PeriodicalIF":0.0,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149182683","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Cancer pain management with concurrent complex gastrointestinal pathology: A case for sublingual buprenorphine.","authors":"Courtney Campbell, Ryan Baldeo","doi":"10.5055/jom.0972","DOIUrl":"https://doi.org/10.5055/jom.0972","url":null,"abstract":"<p><p>A 35-year-old male with a complex gastrointestinal history and metastatic intrahepatic cholangiocarcinoma was hospitalized with intractable cancer-associated pain, unrelieved by oral opioids at escalating doses. Transdermal options were contraindicated due to ozone bath therapy. Given the poor response to previous opioid trials and concerns regarding oral absorption, sublingual buprenorphine was initiated, leading to significant improvement in functional pain control. Despite recurrent malignant bowel obstructions with intolerance to oral intake, the patient consistently maintained tolerable pain control until discharge to hospice services. This case highlights sublingual buprenorphine as an effective strategy for complex cancer pain in patients with limited analgesic routes.</p>","PeriodicalId":16601,"journal":{"name":"Journal of opioid management","volume":"22 5","pages":"541-543"},"PeriodicalIF":0.0,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149182659","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comparison of long-term outcomes between opioid-free and opioid-based anesthesia in head and neck cancer surgeries: A pilot study.","authors":"Nitin Kataria, Geetanjali T Chilkoti, Swati Jain, Medha Mohta, Vipin Arora","doi":"10.5055/jom.0996","DOIUrl":"https://doi.org/10.5055/jom.0996","url":null,"abstract":"<p><p>Background, aim, and objective: Literature is replete with studies evaluating opioid-sparing strategies in head and neck cancer (HNC) surgeries; however, no study has attempted opioid-free anesthesia (OFA). Various long-term outcomes have not been evaluated in any cancer surgeries. This study aimed to compare OFA with standard opioid-based anesthe-sia (OBA) in HNC surgeries. The primary objective was the incidence of chronic post-surgical pain (CPSP), and the sec-ondary objective included Numeric Rating Scale (NRS)-Pain scores, Neuropathic Pain Symptom Inventory (NPSI), Douleur Neuropathique 4 (DN-4), Pain Detect Questionnaire (PDQ), and Short Form-12 (SF-12) scores.</p><p><strong>Materials and method: </strong>Following Instituitional Ethics Committee approval and prospective Clinical Trials Registry-India registration, the study included patients with American Society of Anesthesiologists Physical Status II or III, aged 20-65 years, who were undergoing HNC surgeries. Patients were excluded if they had a history of post-operative nausea, chronic pain, opioid use, local anesthetic allergies, coagulopathies, or cognitive dysfunction. Group OFA received oral pregabalin and dexmedetomidine and ketamine intravenous (IV) infusions perioperatively. Group OBA received standard OBA with IV morphine boluses. The various aforementioned secondary objectives were recorded at the fourth, sixth, eighth, and 12th weeks.</p><p><strong>Result: </strong>Fifty patients, with 25 in each group, were included. The demographic profiles were comparable between the groups. NRS-Pain (Rest) was comparable; however, mean NRS (Cough) and NRS (Swallow) scores were lower in the OF group at the sixth week; however, this difference was not significant. No patients developed CPSP in any group. No sig-nificant differences were recorded in PDQ, NPSI, DN-4, Activity Assessment Scale, and SF-12 scores. Similarly, me-chanical ventilation duration, intensive care unit stay, total hospital stays, and mortality rates were comparable.</p><p><strong>Conclusion: </strong>We did not observe any association between CPSP and OFA in HNC surgeries. Additionally, pain intensity, neuropathic pain component, quality of recovery, and quality of life were comparable.</p>","PeriodicalId":16601,"journal":{"name":"Journal of opioid management","volume":"22 5","pages":"487-498"},"PeriodicalIF":0.0,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149182715","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Rationales for abrupt discontinuation of long-term opioid therapy for chronic pain: A thematic analysis.","authors":"Alexis Grant, Kristina Bogdan, Marianne S Matthias, Adam Hirsh","doi":"10.5055/jom.1012","DOIUrl":"https://doi.org/10.5055/jom.1012","url":null,"abstract":"<p><strong>Objective: </strong>Evidence and clinical guidelines document serious negative health consequences of abrupt discontinuation of long-term opioid therapy (LTOT). Nevertheless, recent studies suggest that up to 80 percent of patients with chronic pain who undergo LTOT deprescribing have their prescriptions abruptly discontinued. Given the frequency and high-risk nature of this practice, it is critical to understand the decision-making processes of physicians implementing abrupt opioid discontinuations while treating patients with chronic pain prescribed LTOT.</p><p><strong>Design: </strong>In the present study, physicians were instructed to imagine working in a primary care setting and taking over the care of patients with chronic pain on LTOT. Physicians were presented with 12 simulated patient vignettes. Physicians indicated how they would manage patients' existing opioid prescription and then described their rationale for these decisions.</p><p><strong>Results: </strong>One hundred physicians participated and completed 1,200 encounters with simulated patients. This study presents thematic analysis of treatment rationales for encounters in which physicians indicated their intention to abruptly discontinue LTOT. Nearly half of physicians (47 percent) immediately discontinued LTOT in at least one patient encounter. An iterative, thematic approach was used to analyze physicians' rationales. The following themes emerged from physician rationales for this action: (1) a preference for first-line treatments for chronic pain, (2) concerns around risk of adverse health consequences, (3) absent or inadequate opioid-related benefit, and (4) a consideration of active pain management strategies.</p><p><strong>Conclusions: </strong>Although physicians frequently considered guideline-relevant -factors-opioid safety risks, potential misuse, and functioning-they often arrived at a guideline-discordant treatment decision, namely abrupt discontinuation.</p>","PeriodicalId":16601,"journal":{"name":"Journal of opioid management","volume":"22 5","pages":"459-465"},"PeriodicalIF":0.0,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149181719","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Opioid-free blended analgesia in patients undergoing thoracic surgery: Preliminary results.","authors":"Francesco Tarantino, Gaetano Ottoveggio, Barbara Verro, Baldassare Renda, Maria Patrizia Mazzotta, Maria Lapi, Carmelo Saraniti","doi":"10.5055/jom.0945","DOIUrl":"https://doi.org/10.5055/jom.0945","url":null,"abstract":"<p><strong>Objective: </strong>Thoracic surgery is recognized as one of the most painful surgical procedures. Opioids represent the most effective analgesic drug for pain management after these procedures. However, opioid use is related to side effects such as nausea, constipation, drowsiness, hypotension, bradycardia. Because of this, recently, studies have focused on blended analgesia, which combines general and loco-regional anesthesia (LRA).This study aims to demonstrate the effectiveness of opioid-free blended anesthesia in pain management in patients undergoing open or endoscopic thoracic surgery.</p><p><strong>Design: </strong>Prospective study.</p><p><strong>Setting: </strong>Tertiary public hospital.</p><p><strong>Patients: </strong>Fifty-four patients undergoing thoracic surgery were enrolled according to criteria: both sexes; aged over 18 years; underwent open or thoracoscopic thoracic surgery; underwent thoracic paravertebral block (TPVB) and/or erector spinae plane block (ESPB), American Society of Anesthesiologist (ASA) between 1 and 4.</p><p><strong>Intervention: </strong>Based on the type of surgery, different types of LRA were performed: TPVB in the case of thoracotomy, ESPB in the case of endoscopic surgery, combination of both techniques in the case of mini-thoracotomy. Patients received Ropivacaine-based LRA and general anesthesia with Sevoflurane, with rescue opioids administered only if necessary.</p><p><strong>Main outcome measure: </strong>Pain assessment was performed with the Numerical Rating Scale 6, 12, 36, 48 hours after surgery.</p><p><strong>Results: </strong>LRA performed included two-level paravertebral blocks in 51.85 percent of cases, two-level ESPBs in 7.41 percent of patients, combination of the two techniques in 40.74 percent of cases. No side effects were recorded during the post-operative period. Vital signs were normal during hospitalization. All patients except one reported pain values of less than 3 during the measurements.</p><p><strong>Conclusions: </strong>This is the first study that demonstrated the effectiveness of opioid-free blended anesthesia after both open and endoscopic thoracic surgery. However, the expertise of the anesthetist is the key for the successful result of this procedure.</p>","PeriodicalId":16601,"journal":{"name":"Journal of opioid management","volume":"22 5","pages":"505-511"},"PeriodicalIF":0.0,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149182700","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}