ROSEMONT, Ill.—To help ensure that patients with active substance use disorder, on medication-assisted treatment, or in abstinent recovery continue to receive high-quality, safe pain management and anesthesia care, the American Association of Nurse Anesthesiology (AANA) has published its updated analgesia and anesthesia practice considerations.
Substance use disorder (SUD) is a chronic brain disease characterized by the recurrent use of substances (e.g., alcohol, drugs) which causes progressive neurological and physiological changes related to judgement, decision making, learning, memory, and behavior control. Research confirms deaths from drug overdoses have more than doubled in the past eight years, from slightly over 52,000 in 2015 to more than 106,000 in 2021, due initially to the over-prescription of pain medications and more recently from the use of street drugs, especially those laced with fentanyl compounds.
”Effective analgesia and anesthesia care for the substance use disorder patient involves managing the physiological and psychological implications of substance use, mitigating withdrawal, and preventing relapse,” said Daniel King, DNP, CRNA, CPPS, AANA Practice Committee chair. “The purpose of these practice considerations is to offer evidence-based guidance for the anesthesia professional in the provision of optimally safe care for the SUD patient. This includes developing an informative, interdisciplinary plan of care in collaboration with the patient. Additionally, Certified Registered Nurse Anesthetists (CRNAs) are well equipped to deploy multimodal, opioid-sparing approaches in pain management, with responsible oversight that includes safe prescribing practices and discharge planning. This reflects an overall emphasis on the patient-centered approach to anesthesia care.”
AANA’s updated practice considerations offer insight on providing optimal care for all patients with substance abuse disorder, with special emphasis for patients using cannabis. Recommendation highlights include utilizing the Cannabis Use Disorder Identification Test (CUDIT-R) to identify cannabis use disorder by tracking the frequency of cannabis use over six months.
“It is important for patients to know the risks and effects of cannabis in anesthesia delivery and share their use history accurately with their anesthesia provider,” said King. “The type of cannabinoid consumed, how it is consumed, frequency, chronicity, and reasons for use are all important factors in determining a patient’s perioperative course. It is critical for anesthesia providers to understand a patient’s history to inform a safe anesthetic and surgical experience.”
Given that regular users of cannabis many have more pain and nausea after surgery, multimodal analgesia is recommended to enhance the delivery of patient-centered care, to reduce surgical stress response, and limit the need for an opioid. Multimodal analgesia refers to the use of more than one pharmacological class of analgesic medication used to treat pain symptoms. Other benefits of multimodal analgesia include early mobilization, decreased length of stay, faster functional recovery, decreased pain scores, and increased patient satisfaction.
CRNAs are highly educated, trained, and qualified anesthesia experts. They provide 50 million anesthetics per year in the United States, working in every setting in which anesthesia is delivered. CRNAs are the primary providers of anesthesia care in rural settings, enabling facilities in these medically underserved areas to offer obstetrical, surgical, pain management, and trauma stabilization services.
