POSTOPERATIVE OPIOID ANALGESIA: SAFETY, PAIN CONTROL AND PREVENTION OF PROLONGED USE

Abstract

Acute postoperative pain remains inadequately controlled in a substantial proportion of surgical patients, while the prescription of opioid analgesics has come to be recognised as a possible gateway to prolonged use of these substances. This twofold problem, which combines undertreatment of pain on one side and unnecessary opioid exposure on the other, requires clinicians to balance analgesic efficacy and safety. The aim of this review was to critically analyse the use of opioids in postoperative analgesia, discussing pharmacological and conceptual foundations, available evidence on efficacy and adverse events, determinants of persistent use and preventive strategies applicable to clinical practice. This is a narrative, critical and descriptive review of the literature, with searches in PubMed/MEDLINE, SciELO, LILACS, Cochrane Library and Google Scholar, prioritising publications from the last fifteen years. Multimodal and procedure-specific analgesia, restriction of prescribing at hospital discharge, risk factors for persistent use, controversies regarding opioid-free anaesthesia and the particularities of the Brazilian context, marked by comparatively low consumption and scarce data, were discussed. It is concluded that the safety of perioperative opioids depends less on their proscription than on judicious indication, the lowest effective dose, limited duration and structured follow-up.