Anesthesia Experts

Determination of the ED90 of Dexmedetomidine Infusion to Prevent Emergence Agitation in Children Undergoing Dental Rehabilitation With Sevoflurane Anesthesia

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AUTHORS: Zhou, Dan MD et al 

Anesthesia & Analgesia 139(4):p 761-769, October 2024.

BACKGROUND:

Emergence agitation (EA) is an adverse complication during early recovery from sevoflurane anesthesia. Continuous intravenous infusion of dexmedetomidine (DEX) is commonly used for EA prevention. However, a wide dose range is used for preventing EA, and the optimal dose remains unknown. This study was aimed at determining the optimal dose (the 90% effective dose [ED90]) of DEX for continuous intraoperative infusion for EA prevention in children.

METHODS:

We enrolled children aged 3 to 7 years who underwent dental treatment under sevoflurane anesthesia. DEX was continuously infused from the time of the establishment of the intravenous access until 5 minutes before the end of surgery. The initial DEX dose was 0.5 µg/kg/h, and subsequent dose adjustments were determined based on the response of the previous patient by using an up-down sequential allocation with a biased-coin design. The primary outcome was the ED90 for continuous DEX infusion based on the success or failure of the EA-preventing dose.

RESULTS:

Forty-five patients were enrolled in the study. The DEX dose ranged from 0.50 to 0.90 µg/kg/h. The estimated ED90 (95% confidence interval [CI]) for preventing EA was 0.74 µg/kg/h (0.67–1.05 µg/kg/h). The duration of surgery (mean ± standard deviation [SD]) was 113 ± 30 minutes. The times (mean ± SD) for extubation, time to emergence, and recovery time were 5 ± 2 minutes, 27 ± 9 minutes, and 39 ± 7 minutes, respectively.

CONCLUSIONS:

The ED90 for continuous intraoperative DEX infusion for EA prevention in pediatric patients receiving dental treatment under sevoflurane anesthesia was 0.74 µg/kg/h (95% CI, 0.67–1.05 µg/kg/h).

Quality of Recovery After Unplanned and Planned Cesarean Deliveries

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AUTHORS: Morales, Juan F. MD et al 

Anesthesia & Analgesia 139(4):p 754-760, October 2024.

BACKGROUND:

There is a paucity of literature examining the differences between patient-reported outcome measures after planned and unplanned cesarean delivery using a validated quality of recovery tool. The Obstetric Quality of Recovery-10 (ObsQoR-10) scoring tool has been validated to quantify functional recovery after cesarean delivery. We aimed to use the ObsQoR-10 to compare the postoperative recovery characteristics of patients undergoing planned and unplanned cesarean deliveries.

METHODS:

We conducted a prospective single-center observational study. Patients undergoing planned and unplanned cesarean deliveries under neuraxial anesthesia were asked to complete the ObsQoR-10 questionnaire 24 hours, 48 hours, and 1 week postpartum. We collected information on total in-hospital postoperative opioid consumption and patients´ perception of readiness for discharge at 24 and 48 hours postpartum. Additionally, patient characteristics were collected to assess their correlation with our findings.

RESULTS:

We included 112 patients (56 in each group). No statistical differences in ObsQoR-10 scores at 24 hours, 48 hours, and 1 week postpartum were observed between the planned and unplanned cesarean deliveries. Additionally, there was no difference between the groups in patients’ perception of readiness for hospital discharge at 24 and 48 hours and opioid consumption in the first 2 days after surgery. Most patients in both groups did not think they would be ready for discharge at 24 hours postpartum. Analysis of the individual components of ObsQoR-10 at 24 hours showed a difference in the responses assessing the severity of shivering (higher in unplanned cesarean deliveries) and the ability to look after personal hygiene (lower in unplanned cesarean deliveries).

CONCLUSIONS:

As assessed by the ObsQoR-10, no significant difference in the quality of recovery was observed between patients undergoing planned and unplanned cesarean delivery.

Perioperative Regional Anesthesia on Persistent Opioid Use and Chronic Pain after Noncardiac Surgery

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AUTHORS: Pepper, Connor G. MD et al 

Anesthesia & Analgesia 139(4):p 711-722, October 2024.

BACKGROUND:

Whether regional anesthesia impacts the development of chronic postsurgical pain is currently debateable, and few studies have evaluated an effect on prolonged opioid use. We sought to systematically review the effect of regional anesthesia for adults undergoing noncardiac elective surgery on these outcomes.

METHODS:

A systematic search was conducted in MEDLINE, EMBASE, CENTRAL, and CINHAL for randomized controlled trials (from inception to April 2022) of adult patients undergoing elective noncardiac surgeries that evaluated any regional technique and included one of our primary outcomes: (1) prolonged opioid use after surgery (continued opioid use ≥2 months postsurgery) and (2) chronic postsurgical pain (pain ≥3 months postsurgery). We conducted a random-effects meta-analysis on the specified outcomes and used the Grading of Recommendations, Assessment, Development, and Evaluations (GRADE) approach to rate the quality of evidence.

RESULTS:

Thirty-seven studies were included in the review. Pooled estimates indicated that regional anesthesia had a significant effect on reducing prolonged opioid use (relative risk [RR] 0.48, 95% CI, 0.24–0.96, P = .04, I2 0%, 5 trials, n = 348 patients, GRADE low quality). Pooled estimates for chronic pain also indicated a significant effect favoring regional anesthesia at 3 (RR, 0.74, 95% CI, 0.59–0.93, P = .01, I2 77%, 15 trials, n = 1489 patients, GRADE moderate quality) and 6 months (RR, 0.72, 95% CI, 0.61–0.85, P < .001, I2 54%, 19 trials, n = 3457 patients, GRADE moderate quality) after surgery. No effect was found in the pooled analysis at 12 months postsurgery (RR, 0.44, 95% CI, 0.16–1.17, P = .10).

CONCLUSIONS:

The results of this study suggest that regional anesthesia potentially reduces chronic postsurgical pain up to 6 months after surgery. Our findings also suggest a potential decrease in the development of persistent opioid use.

KEY POINTS

  • Question: Does the use of regional anesthesia in elective, noncardiac surgery decrease the use of prolonged opioid use and chronic postsurgical pain?
  • Findings: Perioperative regional blocks were associated with reduced rates of prolonged opioid use and chronic pain up to 6 months after surgery.
  • Meaning: Regional anesthesia is an effective part of multimodal analgesic strategies that reduce rates of prolonged opioid use as well as chronic postsurgical pain.

Evolving Roles and Needs: Anesthesiologists and Advocacy

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Authors: Max B. Kelz, MD, PhD; Crystal Wright, MD, FASA
ASA Monitor October 2024, Vol. 88, 35.

At its core, anesthesiology is a clinical specialty dedicated to understanding, optimizing, and preserving the fundamental tenets of life. As physicians, we routinely assume responsibility for ventilatory support, improve oxygenation, and augment hemodynamic parameters, all while suppressing memory formation, blocking perception, and combatting pain. Though most clinicians do not consider themselves scientists, the truth is that anesthesiologists constantly utilize the scientific method. We form hypotheses about what may ail our patients in the ORs, ICUs, and pain clinics; we rapidly intervene using a robust pharmacologic armamentarium; and we verify (or refute) our ideas about the patient’s underlying pathophysiology.

Anesthesiology has a storied history of scientific discovery. In fact, in their review at the turn of the millennium, the editors of the New England Journal of Medicine recognized the development of anesthetics as one of humankind’s greatest breakthroughs (N Engl J Med 2000;342:448). Our specialty has laid the foundations for modern intensive care, cemented in part by Dr. John Severinghaus’ engineering of pO2 and pCO2 electrodes and blood gas analyses, and by Dr. Peter Safar’s development of modern cardiopulmonary resuscitation, which has enabled survival of gravely ill patients in need of critical care services (Anesth Analg 2015;120:663-70). Seminal publications by Dr. Henry Beecher set the standard for ethics in clinical research and remain as important today as they were more than a half century ago.

“Today, we find ourselves at a critical junction. Workforce shortages place immense strain on anesthesiology across the country and threaten the health of our specialty’s research.”

Further building on anesthesiology’s history of scientific commitment and excellence, the Multicenter Perioperative Outcomes Group (MPOG) was established 15 years ago as a visionary big data repository. Today, the MPOG consortium has grown to include more than 100 investigators from more than 50 hospitals across 20 states. It houses perioperative data drawn from 28 million cases containing 63 billion physiologic observations and nearly 500 million medication records. MPOG has facilitated novel retrospective as well as prospective clinical research designed to improve patient care and provide robust feedback to clinicians. It serves as a testament to anesthesiology’s living legacy to enhance patient safety.

Today, we find ourselves at a critical junction. Workforce shortages place immense strain on anesthesiology across the country and threaten the health of our specialty’s research. It is therefore more important than ever to define and advocate for anesthesiology’s moonshot. Fundamental questions remain unanswered, which anesthesiology is ideally positioned to address. These questions include insights into the nature of consciousness itself, into the fabric of memory, and into the neuropsychiatric illnesses where general anesthetics have an increasingly recognized ability to reset ailing brains. Anesthesiology has additional opportunities to lead in the scientific discovery of nonaddictive and novel analgesics that are devoid of opioid-agonist activity, which could combat pain in entirely new ways. Anesthesiology could be developing new therapies to induce hibernation-like states that slow metabolism and consequently circumvent otherwise irreversible ischemic damage – protecting the brain in the setting of a stroke, the heart in the setting of an MI, donor organs prior to transplant surgery, and all vulnerable tissues in the setting of polytrauma.

Discovery and innovation are crucial to advancing anesthesiology, and fundamental insights in basic science and clinical and translational research can be aided through advocacy. Mirroring how anesthesiology itself continues to grow and change, the physician’s role has similarly expanded beyond one-on-one patient interactions to address shared issues. The Rally for Medical Research in Washington, D.C. is one forum through which the Anesthesia Research Council (ARC), ASA, and FAER have gained the ear of policymakers to emphasize the importance of funding for medical research and for the National Institutes of Health to address key issues affecting our patients. This fall, FAER collaborated with the National Academy of Medicine (NAM) to appoint an early-career anesthesiology scholar as the first-ever FAER NAM Fellow. This Fellow will work with the National Academies of Science, Engineering, and Medicine and will participate in public policy alongside National Academy members.

Recent experiences in Washington, D.C. this past May have underscored the importance of physician advocacy, particularly for anesthesiologists (Thorac Surg Clin 2024;34:77-84). During the 2024 ASA LEGISLATIVE CONFERENCE, the society advocated for three primary issues critical to our specialty: opposing the weakening of Veterans’ health care standards, holding health insurance companies accountable, and expanding access to naloxone. While these efforts are crucial to ensuring that today’s patient needs are met, the future of our specialty hinges on addressing multiple concerns and ensuring that we, as advocates, are present to champion the future of anesthesiology in research. Our advocacy efforts, reinforced by the knowledge gained from the ASA LEGISLATIVE CONFERENCE, should be directed toward advocating for a future where anesthesiology continues to thrive and innovate.

Just as research is vital for the advancement of anesthesiology as a specialty, physicians play an integral role in contributing to efforts to improve health care in our society. However, this can only happen if physicians are active in the policymaking process through legislative bodies advocating for our patients’ basic science and clinical needs. Evolving trends in health care necessitate a broader role for physicians. We must step beyond the limits of the traditional physician-patient relationship and embrace our roles as advocates for systemic improvements and scientific discovery. Through advocacy, education, and a commitment to a shared value in improving the care we provide today and tomorrow, we can navigate the complexities of modern health care and ensure that we continue to provide the highest quality care to our patients today and into the future.

ACE Question

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ASA Monitor October 2024, Vol. 88, 25.

Clevidipine and propofol are very similar in appearance; care must be taken to avoid medication errors. © 2022 American Society of Anesthesiologists.

Which of the following BEST describes the primary mechanism for the termination of action of clevidipine?

  • (A) Pulmonary excretion
  • (B) Redistribution into tissue
  • (C) Blood and tissue esterase hydrolysis

Clevidipine is a rapid-acting intravenous dihydropyridine L-type calcium channel antagonist. It has a rapid onset of two to four minutes, with an offset of action of five to 15 minutes. The rapid termination of action is due to the rapid hydrolysis by blood and tissue esterases, similar to the β blocker esmolol. Clevidipine exerts arterial-specific vasodilating effects and is associated with a lowering of afterload by decreasing systemic vascular resistance (SVR), leading to a lower mean arterial pressure (MAP). Because of the selective arterial vasodilating effects, clevidipine has little effect on left ventricular filling pressure or pulmonary capillary wedge pressure. In normotensive patients, it was found to lower pulmonary vascular resistance. In postcardiac surgery patients, clevidipine was found to be effective at lowering MAP and SVR with no effect on cardiac filling pressure, heart rate, or cardiac index.

Clevidipine is relatively insoluble in water and is, therefore, prepared as a lipid emulsion. It has an appearance very similar to propofol (Figure). Therefore, care must be taken to avoid medication errors when these two medications are used. In addition, some concern has been raised regarding the cumulative effect of concurrent infusions of these two lipid-based medications in the critical care setting, especially in patients requiring lipid-based total parenteral nutrition (TPN). At least one case report exists that demonstrated hypertriglyceridemia in the setting of concurrent administration of TPN, clevidipine, and propofol infusion. The termination of action for clevidipine is not related to redistribution or pulmonary excretion.

Answer: C

Discover The Best Anesthesiologist Opportunity in New Mexico

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We are seeking a dedicated anesthesiologist to join our all-anesthesiologist group. Our team will consist of 4 full-time providers and 1 for vacation relief, managing 3 operating rooms.

Position Highlights:

  • Zero call for 3 weeks, followed by 1 week of call without daytime work only call after 7 PM therefore you may not work the entire week.
  • Competitive salary of $500,000 plus benefits.
  • 8 weeks of vacation.

This is the best job on GasWork #370670

Interested? Please contact me at 660-596-2224 or drrob@anesthesiaexperts.com if you or anyone you know would like to apply.

Note: Agencies, please do not contact us as we do not use your service

The Power of Acupuncture for Pain Management

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Author: Dr Nikesh Seth

Feedspot Weekly

Acupuncture, a cornerstone of traditional Chinese medicine, has woven its way into modern pain management practices across the globe. With its roots stretching back thousands of years, acupuncture has gained significant traction in Western medicine as an effective treatment for various types of pain.

What is Acupuncture?

Acupuncture involves the insertion of very thin needles through the patient’s skin at specific points on the body, typically at various depths. Traditionally, it is believed to rebalance the flow of energy or life force — known as chi or qi — through pathways in your body. In Western terms, acupuncture is thought to stimulate nerves, muscles, and connective tissue, which boosts your body’s natural painkillers and increases blood circulation.

Scientific Basis for Acupuncture in Pain Management

Studies suggest that acupuncture triggers the body’s natural pain relief by stimulating the release of endorphins and affecting the part of the brain that governs serotonin, a brain chemical involved with mood. The National Institutes of Health (NIH) and the World Health Organization  (WHO) have recognized acupuncture as an effective treatment for chronic pain conditions such as back pain, neck pain, and osteoarthritis/knee pain.

Types of Pain Treated by Acupuncture

Acupuncture is a versatile treatment that addresses a wide array of pain-related issues. Here’s a closer look at the specific types of pain that acupuncture can help manage:

1. Chronic Pain Conditions

  • Arthritis: Acupuncture is often used to relieve discomfort in cases of both osteoarthritis and rheumatoid arthritis, helping to reduce joint pain and improve mobility.
  • Back Pain: One of the most common reasons people seek acupuncture. It is effective in reducing lower back pain intensity and can improve back function over time.
  • Neck Pain: Acupuncture provides relief from neck pain and neck stiffness and can also treat related conditions like whiplash injuries.
  • Headaches and Migraines: Acupuncture can reduce the frequency and intensity of chronic headaches, including tension headaches and migraines, offering an alternative to traditional painkillers.

2. Acute Pain

  • Menstrual Cramps: Many women find acupuncture treatments helpful for managing the pain and discomfort associated with menstrual cramps.
  • Postoperative Pain: Implementing acupuncture after surgery can significantly reduce the level of pain patients experience and decrease their reliance on opioid painkillers.
  • Dental Pain: Acupuncture can be effective in managing pain associated with dental surgery or chronic conditions affecting the jaw and face (like TMJ disorders).

3. Neuropathic Pain

  • Sciatica: Acupuncture can help relieve the pain and discomfort associated with sciatica, which typically affects the back, hip, and outer side of the leg.
  • Carpal Tunnel Syndrome: Sessions can reduce symptoms and pain in cases of carpal tunnel syndrome, potentially delaying or avoiding the need for surgery.

4. Fibromyalgia

  • Acupuncture has shown promise in treating symptoms of fibromyalgia, including pain, fatigue, and depression, potentially enhancing the quality of life for those affected.

5. Cancer-Related Pain

  • Acupuncture can play a crucial role in the management of cancer-related pain, helping to alleviate discomfort without additional drug load, which can be particularly valuable for those undergoing treatments like chemotherapy.

The Acupuncture Procedure

During an acupuncture session, needles are inserted into specific points along the body’s meridians. Depending on the areas being treated, you may be asked to sit or lie down. The needles are usually retained between five to thirty minutes. Patients often report feeling minimal discomfort as the needles are inserted. The practice should always be carried out by a licensed practitioner to ensure safety and efficacy.

Benefits of Acupuncture Beyond Pain Relief

Acupuncture is more than just a method for alleviating pain; it offers a holistic approach to health that influences several physiological systems in the body. Here’s a deeper look into the multifaceted benefits of acupuncture:

1. Stress Reduction

Acupuncture is known to lower stress hormones and moderate mood to reduce anxiety and improve overall feelings of happiness. It achieves this by calming the nervous system and enabling patients to experience a sense of calm and relaxation during and after sessions.

2. Enhanced Mental Clarity and Increased Energy

Many patients report enhanced mental clarity and a surge of increased energy following acupuncture treatments. This can be attributed to the balancing of the body’s energy flow, which revitalizes both the mind and the body.

3. Improved Sleep

Acupuncture can effectively treat insomnia without the side effects often associated with sleeping pills. By stimulating the production of neurotransmitters that promote relaxation and sleep, acupuncture can help restore natural sleeping patterns.

4. Digestive System Support

Acupuncture can be very effective in regulating the digestive system, which is essential for overall health. It is used to treat a range of digestive disorders, from gastric conditions to irritable bowel syndrome, enhancing the body’s ability to absorb nutrients and eliminate waste.

5. Enhanced Immune System

Regular acupuncture sessions can enhance the immune system by boosting the body’s immune cells, which help fight off pathogens. This can reduce the duration of a cold or the flu and improve the body’s resistance to infections and disease.

6. Relief from Allergies

Acupuncture can be pivotal in the prevention and treatment of allergies by modulating the immune response. When combined with other treatments like herbal medicine, it can help reduce allergy symptoms and reliance on medication.

7. Cardiovascular Benefits

Acupuncture has been shown to lower blood pressure, improve blood circulation, and reduce systemic inflammation, all of which are beneficial for cardiovascular health.

8. Help with Quitting Smoking and Other Addictions

By reducing cravings, lowering stress, and enhancing detoxification, acupuncture can support efforts to quit smoking and other addictive behaviors.

9. Respiratory Health

Acupuncture has been used to treat a range of common respiratory diseases, including asthma, bronchitis, and chronic sinusitis, by reducing inflammation and improving lung function.

10. Pain Relief from Menstrual Cramps and PMS

For women, acupuncture can offer significant relief from the pain associated with menstrual cramps and premenstrual syndrome (PMS), often reducing the need for over-the-counter pain medications.

Integrating Acupuncture into a Comprehensive Pain Management Plan

Acupuncture can be an integral part of a multidisciplinary approach to pain management. It can complement conventional treatments such as medication and physical therapy, providing a synergistic effect that enhances overall pain relief and recovery.

Key Takeaways

Acupuncture offers a promising alternative or supplement to traditional pain management methods. With its low side-effect profile and numerous testimonials to its efficacy, it’s worth considering for those seeking relief from chronic or acute pain.

UnitedHealth $6B in Q3 profit

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This is why they don’t want to pay anesthesia providers it hurts their profit.
UnitedHealth Group reported that total revenues through the first three quarters of the year were $299.5 billion, up from $277.2 billion through the first nine months of 2023.

UnitedHealth Group kicked off another round of earnings calls for major health insurance companies Tuesday morning, when it reported $6.06 billion in profit for the third quarter of 2024.

That’s up slightly from the $5.8 billion the company posted in the third quarter of 2023. However, UnitedHealth has brought in $8.9 billion in profit through the first three quarters of the year, down by close to half from the $16.9 billion reported through the first nine months of 2023.

Perioperative Regional Anesthesia on Persistent Opioid Use and Chronic Pain after Noncardiac Surgery

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Anesthesia & Analgesia 139(4):p 711-722, October 2024.
BACKGROUND: 

Whether regional anesthesia impacts the development of chronic postsurgical pain is currently debateable, and few studies have evaluated an effect on prolonged opioid use. We sought to systematically review the effect of regional anesthesia for adults undergoing noncardiac elective surgery on these outcomes.

METHODS:

A systematic search was conducted in MEDLINE, EMBASE, CENTRAL, and CINHAL for randomized controlled trials (from inception to April 2022) of adult patients undergoing elective noncardiac surgeries that evaluated any regional technique and included one of our primary outcomes: (1) prolonged opioid use after surgery (continued opioid use ≥2 months postsurgery) and (2) chronic postsurgical pain (pain ≥3 months postsurgery). We conducted a random-effects meta-analysis on the specified outcomes and used the Grading of Recommendations, Assessment, Development, and Evaluations (GRADE) approach to rate the quality of evidence.

RESULTS:

Thirty-seven studies were included in the review. Pooled estimates indicated that regional anesthesia had a significant effect on reducing prolonged opioid use (relative risk [RR] 0.48, 95% CI, 0.24–0.96, P = .04, I2 0%, 5 trials, n = 348 patients, GRADE low quality). Pooled estimates for chronic pain also indicated a significant effect favoring regional anesthesia at 3 (RR, 0.74, 95% CI, 0.59–0.93, P = .01, I2 77%, 15 trials, n = 1489 patients, GRADE moderate quality) and 6 months (RR, 0.72, 95% CI, 0.61–0.85, P < .001, I2 54%, 19 trials, n = 3457 patients, GRADE moderate quality) after surgery. No effect was found in the pooled analysis at 12 months postsurgery (RR, 0.44, 95% CI, 0.16–1.17, P = .10).

CONCLUSIONS:

The results of this study suggest that regional anesthesia potentially reduces chronic postsurgical pain up to 6 months after surgery. Our findings also suggest a potential decrease in the development of persistent opioid use.

KEY POINTS

  • Question: Does the use of regional anesthesia in elective, noncardiac surgery decrease the use of prolonged opioid use and chronic postsurgical pain?
  • Findings: Perioperative regional blocks were associated with reduced rates of prolonged opioid use and chronic pain up to 6 months after surgery.
  • Meaning: Regional anesthesia is an effective part of multimodal analgesic strategies that reduce rates of prolonged opioid use as well as chronic postsurgical pain.

Persistent Opioid Use After Hospital Admission From Surgery in New Zealand

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AUTHORS: Gong, Jiayi M Clin Pharm

Anesthesia & Analgesia 139(4):p 701-710, October 2024.

BACKGROUND:

Persistent opioid use (POU) is common after surgery and is associated with an increased risk of mortality and morbidity. There have been no population-based studies exploring POU in opioid-naïve surgical patients in New Zealand (NZ). This study aimed to determine the incidence and risk factors for POU in opioid-naïve patients undergoing surgery in all NZ hospitals.

METHOD:

We included all opioid-naïve patients who underwent surgery without a concomitant trauma diagnosis and received opioids after discharge from any NZ hospital between January 2007 and December 2019. Patients were considered opioid naïve if no opioids had been dispensed to them or if they did not have a prior diagnosis of an opioid-use disorder up to 365 days preceding the index date. The primary outcome was the incidence of POU, defined a priori as opioid use after discharge between 91 and 365 days. We used a multivariable logistic regression to identify risk factors for POU.

RESULTS:

We identified 1789,407 patients undergoing surgery with no concomitant diagnosis of trauma; 377,144 (21.1%) were dispensed opioids and 260,726 patients were eligible and included in the analysis. Of those included in the final sample, 23,656 (9.1%; 95% confidence interval [CI], 9.0%–9.2%) developed POU. Risk factors related to how opioids were prescribed included: changing to different opioid(s) after discharge (adjusted odds ratio [aOR], 3.21; 95% CI, 3.04–3.38), receiving multiple opioids on discharge (aOR, 1.37; 95% CI, 1.29–1.45), and higher total oral morphine equivalents (>400 mg) (aOR, 1.23; 95% CI, 1.23–1.45). Conversely, patients who were coprescribed nonopioid analgesics on discharge had lower odds of POU (aOR, 0.91; 95% CI, 0.87–0.95). Only small differences were observed between different ethnicities. Other risk factors associated with increased risk of POU included undergoing neurosurgery (aOR, 2.02; 95% CI, 1.83–2.24), higher comorbidity burden (aOR, 1.90; 95% CI, 1.75–2.07), preoperative nonopioid analgesic use (aOR, 1.65; 95% CI, 1.60–1.71), smoking (aOR, 1.44; 95% CI, 1.35–1.54), and preoperative hypnotics use (aOR, 1.35; 95% CI, 1.28–1.42).

CONCLUSIONS:

Approximately 1 in 11 opioid-naïve patients who were dispensed opioids on surgical discharge, developed POU. Potentially modifiable risk factors for POU, related to how opioids were prescribed included changing opioids after discharge, receiving multiple opioids, and higher total dose of opioids given on discharge. Clinicians should discuss the possibility of developing POU with patients before and after surgery and consider potentially modifiable risk factors for POU when prescribing analgesia on discharge after surgery.

KEY POINTS

  • Question: What are the incidence and risk factors for persistent opioid use among opioid-naïve surgical patients who received opioids on discharge from any hospital in New Zealand?
  • Findings: One in 11 patients developed persistent opioid use. On discharge, patients who changed to different opioids, received multiple opioids, or given higher doses of opioids had an increased risk of persistent opioid use.
  • Meaning: While the incidence of persistent opioid use after surgery is comparable to other high-income countries, several risk factors relating to opioid prescribing practices can potentially be modified to reduce this risk.
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