Anesthesia Management: Getting Hooked on Pain Meds Postoperatively

Authors: Clarke H et al., BMJ 2014 Feb 11; 348:g1251

A small but substantial percentage of opiate-naïve patients were still taking pain medications 90 days after major surgery.

Annually, more than 200 million patients undergo major surgery worldwide. Many patients require treatment with opiates for moderate-to-severe postoperative pain; most quickly transition off of pain medications. However, the number of opiate-naïve patients who remain on chronic opioids postoperatively is unknown.

Researchers conducted a retrospective, observational study of older patients (age ≥66) with no prior use of opioids who underwent one of nine major elective surgical procedures (cardiac, intrathoracic, abdominal, or pelvic) in Ontario, Canada, during a 7-year period. Among >39,000 patients analyzed, 49% were discharged with opioid prescriptions, and 3% used opioids for >90 days following surgery. Type of surgical procedure was associated with opioid use, with intrathoracic procedures conferring the highest risk. In adjusted analyses, patient-related risk factors associated significantly with higher risks for prolonged opioid use included lower household income, specific comorbidities (i.e., diabetes, heart failure, and pulmonary disease), and use of specific drugs preoperatively (i.e., benzodiazepines, selective serotonin reuptake inhibitors, and angiotensin-converting–enzyme inhibitors).

Comment

Whether the results of this study are generalizable to other populations, such as younger patients or those most likely to use opiates preoperatively (e.g., patients with severe osteoarthritis), is unclear. Although the percentage of opiate-naive patients who become dependent on pain meds postoperatively is relatively low on an individual basis (3%), the population number of greater than 6 million represents a public health concern. Understanding specific surgical and patient risk factors that are associated with long-term use of opioids postoperatively will better define subgroups who warrant preventive interventions.