Pain Management After Ophthalmic Surgery: Considerations During the Opioid Epidemic

To examine the current state of post-operative pain management in ophthalmic surgery, and highlight the unique challenges and opportunities within the context of the opioid crisis.

Recent studies highlight the need to reassess opioid prescription practices in ophthalmology. The adoption of non-opioid strategies, including non-steroidal anti-inflammatory drugs (NSAIDs), steroids, neuropathic medications, and acetaminophen, have proven to be effective and safer alternatives for post-operative pain management. Implementing guidelines and legislative measures has shown substantial potential for reducing opioid over-prescription and improving patient outcomes as well. Practicing judicious opioid prescription practices within ophthalmology is thus feasible, and may adequately control pain while minimizing opioid-related morbidity.

Opioid use has been a cornerstone of pain management in medicine for centuries, but its association with addiction and mortality has driven the need for reform in prescription practices. Ophthalmic surgery encompasses a wide range of procedures, from minimally invasive cataract surgery to more-involved oculoplastic and orbital surgeries, as well as potentially painful epithelial debridement during corneal surgeries. As such, ophthalmologists are challenged with prescribing various pain management regimens to adequately control post-operative pain while minimizing adverse effects. In response to the opioid crisis, a profound shift has occurred in the approach to post-operative pain management within ophthalmology. Non-opioid alternatives, guided by evidence-based guidelines, have proven to be effective and safe in achieving adequate pain control. Additionally, the implementation of guidelines and legislative measures have reduced opioid over-prescription and enhanced patient outcomes. Engaging in ongoing education and quality improvement initiatives, implementing appropriate prescription practices, and adopting multimodal, non-opioid pain management strategies within ophthalmology are thus essential for mitigating the impact of the opioid crisis and optimizing patient outcomes.