Monitoring of Opioid Analgesic Use and Its Effects in Acute Care

There has been a dramatic rise in deaths attributed to opioid use in the last decade, and with the recognition of prescription opioids as a significant contributor, the use of opioids in healthcare has become heavily scrutinized. However, despite a renewed interest in opioid sparing multimodal pain management strategies, opioids remain the most effective pain modality for severe acute pain. Also, with national guidelines emphasizing analgo-sedation (treat pain first), opioids are the cornerstone of sedation and analgesia practices in intensive care units. However, in the absence of appropriate cardiorespiratory monitoring, the side-effect profile of opioids can have dire consequences. Over the past decade, opioid consumption and adverse event prevention have been studied extensively with new technologies emerging to assist clinical decision making. Algorithms and protocols have been standardized taking many factors into consideration prior to subjectively determining if a verbal or nonverbal patient has adequate pain control. We here present an overview of the technology available to monitor opioid use and overdose, algorithms for various grades of sedation, personnel expertise, and certification required to safely administer opioids in acute care setting and methods to identify at-risk patient groups.