POSTOPERATIVE OPIOIDS: BALANCING PAIN CONTROL, ADVERSE EVENTS, AND THE RISK OF DEPENDENCE

Abstract

Acute postoperative pain is one of the most prevalent symptoms associated with surgical procedures and, when poorly controlled, is associated with greater morbidity, slower functional recovery, and a risk of chronification. Opioids remain central tools for treating moderate to severe pain in this scenario, but their use requires reconciling analgesic efficacy, the occurrence of adverse events, and the potential for prolonged use and dependence. This narrative review, of a critical and descriptive nature, aimed to analyze the available evidence on the use of opioids in the postoperative period, distinguishing in-hospital care from prescribing after discharge. A search was conducted in the PubMed/MEDLINE, SciELO, LILACS, Cochrane Library, and Google Scholar databases, prioritizing publications from the last fifteen years. The conceptual foundations, the clinical relevance of inadequate pain control, analgesic efficacy and prescribing patterns, adverse events and safety, persistent use in opioid-naive patients, tolerance, hyperalgesia, and dependence, as well as harm-reduction strategies organized by risk profile, were discussed. The evidence indicates that multimodal strategies, judicious prescribing, and post-discharge follow-up are decisive elements in reconciling effective pain relief and patient safety.