ReviewCurrent pain and headache reports2026
Perioperative Pain in the Era of Emerging and Unregulated Substances: Recognition, Risk Assessment, and Management.
Review in Current pain and headache reports, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
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Authors and funding
3 authors.
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Abstract
purpose of reviewThis review examines the perioperative implications of selected substances in the contemporary unregulated drug supply and outlines a physiology-based approach to preoperative assessment, risk recognition, and postoperative pain management. RECENT
findingsPatients may be exposed intentionally or unknowingly to fentanyl and nitazenes, xylazine and medetomidine, kratom and concentrated 7-hydroxymitragynine products, tianeptine, phenibut, and other psychoactive substances. Clinically important patterns include respiratory depression, prolonged sedation, bradycardia, hypotension, opioid tolerance, withdrawal, and difficult postoperative pain. Polysubstance exposure, uncertain product composition, and limitations of routine toxicology screening may complicate identification of the responsible substance. Perioperative assessment should emphasize specific, nonjudgmental history taking, recognition of physiologic patterns, and individualized risk stratification rather than reliance on identification of a specific substance. Perioperative planning should integrate physiologic findings with the limitations of toxicology testing and distinguish surgical pain from tolerance, withdrawal, opioid-induced hyperalgesia, and delirium. Awareness of a geographically variable and rapidly evolving drug supply is increasingly important for safe perioperative care.
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Registered trials
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