Why we are recommending this best practice
Shared decision making is a dynamic process during which the provider and patient engage in an informed discussion to make health related choices that are best for the patient and in alignment with the patient’s personal values (refer the Resources section of this Best Practice for more information), Shared decision making has been shown to reduce overall opioid use.
Strategies for implementation
- For each patient with OUD, engage in an open and honest discussion about pain control and encourage shared decisions about pain management.
- Consider Transverse Abdominis Plane (TAP) block, Quadratus Lumborum Block (QL2), or paravertebral blocks/catheters with the consultation of an anesthesiologist. Create facilities, training, and procedures for providers to maintain these catheters and advise patients on their benefits and use.
- Schedule adjuvant medications including non-steroidal anti-inflammatory medications and acetaminophen to reduce the need for opioid dose escalation. Develop procedures and training for the administration of other adjuvant medications including gabapentin or pregabalin, or short-term ketamine in consultation with and under the supervision of an anesthesiologist.
- Consider local analgesic and other analgesic patches for postsurgical pain.
- Do not routinely give opioids above maintenance doses for vaginal births.
- Seek your patient’s participation
- Help your patient explore and compare treatment options
- Assess your patient’s values and preferences
- Reach a decision with your patient
- Evaluate the decision
- Ramsay Sedation Scale: Designed for use in critically ill adults that has broad applicability in evaluation of the range between agitation and over sedation in response to sedatives and analgesics.
- COWS: A clinical opioid withdrawal scale designed to monitor signs of opioid withdrawal.
- Considerations for Administration of Buprenorphine and Methadone.
- Considerations for Treatment of Opioid Use Disorder in Pregnancy.
- “SHARE Approach” AHRQ. Shared Decision Making.
- Ansari J, Carvalho B, Shafer SL, Flood P. Pharmacokinetics and pharmacodynamics of drugs commonly used in pregnancy and parturition. Anesth Analg. 2016;122(3):786-804. doi: 10.1213/ANE.0000000000001143.