The rising tide of opioid use and abuse: the role of the anesthesiologist.

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Opioid use has risen dramatically in the past three decades. In the USA, opioid overdose has become a leading cause of unintentional death, surpassing motor vehicle accidents. A patient's first exposure to opioids may be during the perioperative period, a time where anesthesiologists have a significant role in pain management. Almost all patients in the USA receive opioids during a surgical encounter. Opioids have many undesirable side effects, including potential for misuse, or opioid use disorder. Anesthesiologists and surgeons employ several methods to decrease unnecessary opioid use, opioid-related adverse events, and side effects in the perioperative period. Multimodal analgesia, enhanced recovery pathways, and regional anesthesia are key tools as we work towards optimal opioid stewardship and the ideal of effective analgesia without undesirable sequelae.





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Koepke, Elena J, Erin L Manning, Timothy E Miller, Arun Ganesh, David GA Williams and Michael W Manning (2018). The rising tide of opioid use and abuse: the role of the anesthesiologist. Perioperative medicine (London, England), 7. p. 16. 10.1186/s13741-018-0097-4 Retrieved from

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Timothy Ellis Miller

Professor of Anesthesiology

Clinical and research interests are Enhanced Recovery and Perioperative Medicine; with particular interests in fluid management, and perioperative optimization of the high-risk non-cardiac surgery patient.


Arun Ganesh

Assistant Professor of Anesthesiology

I am an anesthesiologist and pain medicine specialist. My research focuses on use of sympathetic nerve blocks for treatment of cardiac conditions.  We study the efficacy of stellate ganglion blocks for treatment of refractory ventricular arrhythmias, and splanchnic nerve blocks for treatment of acute and chronic heart failure.  Outside of work I enjoy playing tennis, drums, and spending time with my wife and two sons. 


Michael Wayne Manning

Associate Professor of Anesthesiology

Dr. Michael W. Manning, MD, Ph.D., is an Associate Professor at Duke University Medical Center, within the Divisions of Cardiothoracic and General, Vascular, and Transplant anesthesia. He serves as the director of Enhanced Recovery after Surgery programs and the director of research for the Perioperative Medicine Fellowship at Duke. His clinical practice focuses on high-risk cardiac surgery, Heart, Lung, and Liver transplantation.

Dr. Manning earned a Ph.D. in cardiovascular physiology from the University of Kentucky, where he studied the role of Angiotensin II-mediated inflammation in the development of abdominal aortic aneurysms. After graduate school, Dr. Manning remained at the University of Kentucky, earning his MD degree. He completed a year of general surgery residency before switching to anesthesia. Following residency, Dr. 
Manning continued his clinical training at Duke University with a one-year clinical fellowship in Adult Cardiothoracic Anesthesiology and a 2-year research fellowship. He joined the Duke faculty in 2014. 

His current research interests are ERAS centered, specifically in the role of opioid-free anesthesia and goal-directed fluid therapy in cardiac surgery on renal outcomes.

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