to the success of ISCR protocols is patient participation in preoperative discussions regarding
expectations for postoperative pain.
Whenever possible, surgeons should use ISCR
principles of pain management to enhance perioperative care and reduce narcotic use.
Informed consent platform
Informed consent is an essential element of quality
medical care. Classic tenets of informed consent
include a discussion of the recommended procedure
and its rationale, as well as the risks and benefits
of the procedure, any alternative treatments, and
what may happen if no treatment is provided.
Despite patient concerns regarding postoperative
pain and the potential for opiate addiction, the
data suggest that pain is rarely discussed during
the informed consent process.
34, 35 A 2016 survey
of 552 patients who had completed an informed
consent demonstrated that although 65 percent
of patients wanted to know the risk of developing
chronic pain after an operation, 34 percent did not
know the risk of chronic postoperative pain when
In addition to managing patient expectations,
full disclosure regarding risks of acute opioid therapy is important from a medicolegal perspective.
Cheatle and Savage argue that because individual
patient vulnerability to opioid misuse and addiction
is unpredictable, informed consent on the opioid
issues of tolerance, dependence, and hyperalgesia is essential to minimizing patient-physician
conflict and limiting liability.
36 Although satisfying legal requirements is sufficient motivation for
informed consent, surgical informed consent that
honors patient autonomy will include a thorough
discussion of opioid-related risks and benefits and
will use educational interventions when necessary.
In this way, informed consent can be a powerful
tool that can help surgeons structure their patient-centered conversations to set realistic expectations
and effectively motivate and facilitate an opioid-sparing pain management strategy.
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