Comment éviter la dépendance aux opiacés en postopératoire ?

Opioids are used for severe postoperative pain treatment. However, there is a risk of misuse and addiction, related to breeding conditions (mood), background, opioids (tolerance/addiction) and persistent pain after surgery. A chronic postsurgical pain (CPSP) is the first risk factor of addiction. Prevention is based on screening of patients at risk during anesthetic consultation. Sparing opioid analgesia in these patients is based on the use of regional anesthesia, alpha 2 adrenergic agents, NMDA blockers. Postoperative used of opioids is limited to a couple of days in patients at risk. Persistent or resurgence of pain, some weeks after surgery, forces identification of neuropathic pain components and their appropriate treatment. Mental health and social component also need to be managed. Misuse or addiction symptoms refer the patient to a specialist.