New study shows how pain management practices change after surgery

New study shows how pain management practices change after surgery

According to a study of more than a quarter of a million Canadian patients presented at the 2022 ANESTHESIOLOGY® Annual Meeting, while there has been no decrease in the number of opioid prescriptions seniors receive after surgery, the dosage of those prescriptions is lower.

While it is good news that opioid prescription dosages are being reduced, the fact that the actual number of opioid prescriptions filled has remained the same shows that there is still room for improvement. This is particularly true for procedures that involve minor postoperative pain, which can be effectively controlled with non-opioid medications such as acetaminophen and nonsteroidal anti-inflammatory drugs (NSAIDs).”

Naheed Jivraj, MBBS,MS, FRCPC, lead author of the study and Fellow in Critical Care Medicine, University of Toronto, Ontario

While opioids can be an important part of pain management after surgery, it is important to limit their use, including by reducing the dose, because they have serious side effects and can lead to dependence and a potentially fatal overdose.

To assess trends in pain prescription fills in the week following surgery, researchers examined the records of 278,366 patients, representing all Ontario adults over the age of 65, who underwent one of 14 surgical procedures between 2013 and 2019. Surgical procedures in the study included: thyroid removal, appendectomy, hernia repair, laparoscopic or open gallbladder removal, prostate removal, open heart surgery, laparoscopic or open colon removal, laparoscopic vaginal or abdominal hysterectomy, breast removal, hip and Knee replacement.

They found an increase in patients filling non-opioid prescriptions (e.g. acetaminophen or NSAID) from 9% in 2013 to 28% in 2019. They found that most patients continued to receive a prescription that contained an opioid -; 76% in 2013 and 75% in 2019. However, the dosage of opioid prescriptions fell from an average of 317 MME (morphine milligram equivalent) in 2013 to an average of 260 MME in 2019.

Most patients undergoing procedures such as appendix or thyroid removal can experience pain relief with acetaminophen or an NSAID; However, researchers found that few patients who underwent these procedures filled prescriptions for these non-opioid alternatives.

“Our study shows how pain management practices change after surgery,” said Dr. Jivraj. “The increase in seniors filling non-opioid prescriptions and lower opioid dosage may be due to the development of surgery-specific prescribing guidelines and the increasing use of anesthesiologist-advocated Enhanced Recovery After Surgery protocols and other programs focused on improving patient outcomes.”

Source:

American Society of Anesthesiologists

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