Page 44 - CASA Bulletin of Anesthesiology 2019 Vol 6 No 5

CASA Bulletin of Anesthesiology

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Translational Perioperative and Pain Medicine
ISSN: 2330-4871

Review Article | Open Access Volume 6 | Issue 4
Implications of Chronic Opioid Therapy on Perioperative
Complications and Long-Term Surgical Recovery

Da Liu MD , Matthew DiMeglio MBA , Michael DiMartino , Jihane Hajj DNP , Maria Mukhanova ,
4
1,2
7
5,6
3
Karima Rai , Mazell Winikor MD , Krzysztof Laudanski MD, PhD, MA, FCCM 2,8*
2
7
1 Department of Gynecology and Obstetrics, Shengjing Hospital of China Medical University,Shenyang, Liaoning, China
2 Department of Anesthesiology and Critical Care, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
3 DO/MBA Student, Philadelphia College of Osteopathic Medicine, Philadelphia, PA, USA
4 Department of Biology, University of Pennsylvania, Philadelphia, PA, USA
5 Department of Cardiology, Penn Presbyterian Medical Center, Philadelphia, PA, USA
6 Department of Nursing, Widener University, Chester, PA, USA
7 Department of Biology, Drexel University, Philadelphia, PA, USA
8 Leonard Davis Institute for Health Economics, University of Pennsylvania, Philadelphia, PA, USA
Abstract therapy are beginning to be described in the literature
[2,6,7]. Overall, the exposure of the public to opioids is
With chronic opioid use becoming an increasingly common increasing and the nature of opioid ingestion is chang-
occurrence among the general population, perioperative
specialties must adapt to the physiologic changes caused ing towards chronic intake. Furthermore, some of the
by long-term opioids. However, data on the clinical anes- exposure takes place at earlier ages and even during fe-
thetics implications of long-term opioid use is scarce. This tal development. The effect of chronic opioids exposure
review intends to survey the literature addressing the mo- during at the developmental age is profound yet the
lecular mechanisms of long-term opioid use as well as their scientific community has yet to grasp its clinical impact.
interaction with various organ systems.
It is a matter of curiosity to ask how the health con-
Keywords
sequences of chronic intake of opioids will affect medi-
Opioids, Mu receptor, Kappa receptor, Mu-delta receptor, cal decision-making during anesthesia and surgery. The
Morphine, Hydromorphone, Fentanyl
focus of this review is to examine the biological effects
of prolonged exposure to opioids as it relates to their
Background significance in adapting an anesthetic plan. We will fo-
Opioid use and abuse has been consistently increas- cus on exogenous opioids and not comment about the
ing in the United States over the past decade with an natural ligands of opioid receptors. We will not address
estimated 4.3 million adults regularly taking opioids the issue of prolonged use of ketamine and cocaine and
[1,2]. Of these individuals, it is estimated that up to other pharmacological compounds with mixed receptor
29% exhibit opioid misuse and 12% exhibit opioid ad- mechanisms, except methadone. The latter compound
diction behaviors [2]. Concomitant abuse of heroin and has several quite unique properties, but its importance
the synthetic opioid, fentanyl, have contributed to a re- in management of chronic pain warrants inclusion. Opi-
cent dramatic increase in overdose deaths. Increase in oids will be defined as the compounds interacting solely
illicit substance abuse in general, increased incidence of with mu (μ), kappa (κ), and delta (δ) receptor. We will
chronic pain, pressure on providers to ensure patient’s not investigate the chronic effects of sigma (σ) receptor
optimal experience in hospital, the introduction of pain stimulation since it is not triggered by endogenous opi-
as fifth vital sign and, most importantly, the influence of oids. Also, we will not address the biological importance
pharmaceutical companies has led to a “perfect storm” of nociceptors or the opioid growth factor receptor
in the USA [4]. Opioid use has also become a global ep- (OGFR or ζ receptor) considering ongoing controversies
idemic, with areas such as Eastern Europe, North Afri- related to those receptors’ pharmacokinetics and highly
ca, and the Middle East exhibiting high prevalence of dynamic evolution of their science. Finally, we will fo-
opioid-dependence [5]. The use of opioids have also cus on long-term consequences of opioid use defined as
shifted from an acute therapy to chronic management longer than three months of consistent use. This defini-
of pain, and the detrimental effects of long-term opioid tion is somewhat arbitrary, yet most of the patients will

Transl Perioper & Pain Med 2019; 6 (4) DOI: 10.31480/2330-4871/099 • Page 120 •

IMPLICATIONS OF CHRONIC OPIOID THERAPY
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