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Comment on: Feasibility study on elimination of all oral opioids following bariatric surgery

      Systemic administration of opioids for short-term postoperative pain has been shown to increase risks for chronic opioid use among a diverse range of patient populations [
      • Soneji N.
      • Clarke H.A.
      • Ko D.T.
      • Wijeysundera D.N.
      Risks of developing persistent opioid use after major surgery.
      ]. Bariatric surgery patients may be at particularly high risk for chronic opioid use and misuse postoperatively, as extreme obesity is associated with higher rates of chronic pain, opioid use, and substance misuse [
      • King W.C.
      • Chen J.Y.
      • Belle S.H.
      • et al.
      Use of prescribed opioids before and after bariatric surgery: prospective evidence from a U.S. multicenter cohort study.
      ]. Additionally, anatomic and physiologic changes from some bariatric procedures (e.g., Roux-en-Y gastric bypass [RYGB]) accelerate the rate and extent of opioid absorption, which may increase opioid use motivation [
      • King W.C.
      • Chen J.Y.
      • Belle S.H.
      • et al.
      Use of prescribed opioids before and after bariatric surgery: prospective evidence from a U.S. multicenter cohort study.
      ]. In response, recent bariatric surgery clinical practice guidelines cosponsored by 5 societies, including the American Society for Metabolic and Bariatric Surgery, recommend the use of preemptive, standard, opioid-sparing, multimodal analgesia [
      • Mechanick J.I.
      • Apovian C.
      • Brethauer S.
      • Garvey W.T.
      • Joffe A.M.
      • Kim J.
      Clinical practice guidelines for the perioperative nutrition, metabolic, and nonsurgical support of patients undergoing bariatric procedures–2019 update: cosponsored by American Association of Clinical Endocrinologists/American College of Endocrinology, The Obesity Society, American Society for Metabolic and Bariatric Surgery.
      ].
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      References

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        • Clarke H.A.
        • Ko D.T.
        • Wijeysundera D.N.
        Risks of developing persistent opioid use after major surgery.
        JAMA Surg. 2016; 151: 1083-1084
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        Surg Obes Relat Dis. 2017; 13: 1337-1346
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        Clinical practice guidelines for the perioperative nutrition, metabolic, and nonsurgical support of patients undergoing bariatric procedures–2019 update: cosponsored by American Association of Clinical Endocrinologists/American College of Endocrinology, The Obesity Society, American Society for Metabolic and Bariatric Surgery.
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        Bull Am Coll Surg. 2019; (Available at: https://bulletin.facs.org/2019/01/erabs-leads-to-reduced-opioid-use-among-bariatric-surgery-patients/. Accessed April 23, 2021.)
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        Feasibility study on elimination of all oral opioids following bariatric surgery.
        Surg Obes Relat Dis. 2021; 17: 1069-1079

      Linked Article

      • Comment on: Feasibility study on elimination of all oral opioids following bariatric surgery
        Surgery for Obesity and Related DiseasesVol. 17Issue 6
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          With opioid abuse at epidemic proportions, conventional wisdom would support avoidance of narcotic pain medications in the postoperative period. However, we typically do not promote conventional wisdom, and instead seek scientific data to support our recommendations. Meyers et al. [1] have provided us with some well-thought-out scientific data, and for that they should be commended. However, their investigation leaves us with a few unanswered questions:
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      • Feasibility study on elimination of all oral opioids following bariatric surgery
        Surgery for Obesity and Related DiseasesVol. 17Issue 6
        • Preview
          The bariatric population is at increased risk for developing chronic opioid dependence. The practice of prescribing oral opioids for analgesia in postoperative ambulatory settings is a known risk factor for developing chronic opioid dependence. The use of oral opioids following minimally invasive bariatric surgery may not be necessary.
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