EVALUATION OF OPIOID DEPENDENCE RISK IN SURGICAL PATIENTS: IMPLICATIONS OF PROLONGED OPIOID USE FOR POSTOPERATIVE PAIN MANAGEMENT

Abstract

The objective of this study was to analyze the risk of opioid dependence in patients undergoing surgical procedures and the effects of prolonged opioid use during the postoperative period. A narrative literature review was conducted between 2013 and 2023 using health science databases, including original studies involving human subjects, published in Portuguese and English, that addressed postoperative opioid use, related risk factors, and the occurrence of dependence. Case reports, review articles, animal studies, and publications outside the established period were excluded. The results demonstrated that the continuation or prolonged use of opioids after hospital discharge was associated with an increased risk of dependence, as well as complications such as pharmacological tolerance, withdrawal syndrome, and opioid-induced hyperalgesia. The main risk factors identified included younger age, history of substance abuse, chronic pain, psychiatric comorbidities, high cumulative doses, and the absence of multimodal analgesic strategies. Multimodal analgesia, combining non-opioid medications, regional techniques, and adjuvant therapies, consistently reduced opioid exposure during the perioperative period, in addition to reducing adverse events and improving functional recovery. It is concluded that preventing opioid dependence in surgical patients requires careful prescribing, individualized protocols, education of patients and multidisciplinary teams, as well as continuous postoperative monitoring, prioritizing multimodal approaches to promote greater safety and better clinical outcomes.