Opioid and Nonopioid Strategies in Perioperative Care : A National Web-Based Survey of Swedish Healthcare Professionals
(2026) In Pain Management Nursing- Abstract
Purpose Despite increased interest in opioid-free strategies, their clinical uptake remains limited. This study explores Swedish perioperative healthcare professional’s (HCPs) knowledge, attitudes, and practices regarding opioid and nonopioid analgesia across intraoperative and postoperative contexts. Design A national web-based survey was conducted among perioperative HCPs across Sweden between October 2023 and January 2024. Methods The questionnaire, based on the Knowledge, Attitudes, Practices (KAP) model, included closed- and open-ended items addressing intra and postoperative pain management. Quantitative data were analyzed using nonparametric statistics, and qualitative responses were examined using deductive thematic analysis... (More)
Purpose Despite increased interest in opioid-free strategies, their clinical uptake remains limited. This study explores Swedish perioperative healthcare professional’s (HCPs) knowledge, attitudes, and practices regarding opioid and nonopioid analgesia across intraoperative and postoperative contexts. Design A national web-based survey was conducted among perioperative HCPs across Sweden between October 2023 and January 2024. Methods The questionnaire, based on the Knowledge, Attitudes, Practices (KAP) model, included closed- and open-ended items addressing intra and postoperative pain management. Quantitative data were analyzed using nonparametric statistics, and qualitative responses were examined using deductive thematic analysis aligned with the KAP model. Results Knowledge gaps predominated: 39% of all respondents were unsure of intraoperative opioid-free evidence, and 37% of postoperative anesthesiologists scored lower than nurse anesthetists and critical-care nurses (p ' .01). Attitudes were pragmatic but opioid-centric: 89% were satisfied with current practice, and 87% deemed opioids essential, though most favored dose reduction over elimination, citing vague opioid-free anesthesia (OFA) definitions and case-specific risk. Practice mirrored attitudes: 68% did not primarily use opioid-free medications intraoperatively, blocks were common yet rarely audited. Nonpharmacological options were rarely used postoperatively: 23% routinely offered TENS, typically delivered by nurses or physiotherapists, while 59% relied primarily on opioids. Conclusions Perioperative pain management remains predominantly opioid-based, yet respondents showed openness toward individualized, opioid-free strategies. Clinical Implications Key barriers included limited knowledge among HCPs, conceptual ambiguity around OFA, and low routine use of non-pharmacological methods. Targeted education, outcome evaluation, and team-based protocols are needed to bridge the gap between the evidence and practice.
(Less)
- author
- Diwan, Salwan ; Sjöberg, Carina LU and Jildenstål, Pether LU
- organization
- publishing date
- 2026
- type
- Contribution to journal
- publication status
- epub
- subject
- keywords
- Healthcare professionals, Knowledge-Attitudes-Practice model, Opioid-free anesthesia, Perioperative pain management, Transcutaneous electrical nerve stimulation
- in
- Pain Management Nursing
- publisher
- Elsevier
- external identifiers
-
- pmid:41580371
- scopus:105028415393
- ISSN
- 1524-9042
- DOI
- 10.1016/j.pmn.2025.12.018
- language
- English
- LU publication?
- yes
- additional info
- Publisher Copyright: Copyright © 2025. Published by Elsevier Inc.
- id
- f2ef3a83-6734-4967-936a-ff062797a261
- date added to LUP
- 2026-02-25 09:59:38
- date last changed
- 2026-02-26 03:00:11
@article{f2ef3a83-6734-4967-936a-ff062797a261,
abstract = {{<p>Purpose Despite increased interest in opioid-free strategies, their clinical uptake remains limited. This study explores Swedish perioperative healthcare professional’s (HCPs) knowledge, attitudes, and practices regarding opioid and nonopioid analgesia across intraoperative and postoperative contexts. Design A national web-based survey was conducted among perioperative HCPs across Sweden between October 2023 and January 2024. Methods The questionnaire, based on the Knowledge, Attitudes, Practices (KAP) model, included closed- and open-ended items addressing intra and postoperative pain management. Quantitative data were analyzed using nonparametric statistics, and qualitative responses were examined using deductive thematic analysis aligned with the KAP model. Results Knowledge gaps predominated: 39% of all respondents were unsure of intraoperative opioid-free evidence, and 37% of postoperative anesthesiologists scored lower than nurse anesthetists and critical-care nurses (p ' .01). Attitudes were pragmatic but opioid-centric: 89% were satisfied with current practice, and 87% deemed opioids essential, though most favored dose reduction over elimination, citing vague opioid-free anesthesia (OFA) definitions and case-specific risk. Practice mirrored attitudes: 68% did not primarily use opioid-free medications intraoperatively, blocks were common yet rarely audited. Nonpharmacological options were rarely used postoperatively: 23% routinely offered TENS, typically delivered by nurses or physiotherapists, while 59% relied primarily on opioids. Conclusions Perioperative pain management remains predominantly opioid-based, yet respondents showed openness toward individualized, opioid-free strategies. Clinical Implications Key barriers included limited knowledge among HCPs, conceptual ambiguity around OFA, and low routine use of non-pharmacological methods. Targeted education, outcome evaluation, and team-based protocols are needed to bridge the gap between the evidence and practice.</p>}},
author = {{Diwan, Salwan and Sjöberg, Carina and Jildenstål, Pether}},
issn = {{1524-9042}},
keywords = {{Healthcare professionals; Knowledge-Attitudes-Practice model; Opioid-free anesthesia; Perioperative pain management; Transcutaneous electrical nerve stimulation}},
language = {{eng}},
publisher = {{Elsevier}},
series = {{Pain Management Nursing}},
title = {{Opioid and Nonopioid Strategies in Perioperative Care : A National Web-Based Survey of Swedish Healthcare Professionals}},
url = {{http://dx.doi.org/10.1016/j.pmn.2025.12.018}},
doi = {{10.1016/j.pmn.2025.12.018}},
year = {{2026}},
}