Evaluating Age as a Predictor of Postoperative Opioid Use and Prescribing Habits in Older Adults With Cancer

Intrathecal Morphine vs Paravertebral Nerve Blocks for Analgesia After Breast Reconstruction With Abdominally Based Free Flaps

BACKGROUND

Breast reconstruction with abdominally based free flaps can be associated with more significant acute pain and longer hospital stays than implant-based techniques. As new pain management strategies are developed, there have not been any studies conducted to analyze the analgesic effects of intrathecal morphine (ITM) for patients undergoing abdominally based free flap reconstruction.

OBJECTIVES

The primary outcome analyzed in this retrospective study was opioid consumption, which was measured from the postoperative anesthesia care unit (PACU) through postoperative day (POD) 2. Secondary outcomes of the study analyzed included factors such as pain scores, hospital length of stay (LOS), and adverse effects.

METHODS

Fifty-one patients presented for breast reconstruction with abdominally based free flaps and received ITM for postoperative analgesia. Results obtained were compared with a cohort that included an equal number of patients who received paravertebral nerve blocks (PVBs).

RESULTS

Results showed that patients who received ITM displayed a lower median consumption in the PACU (0 mg vs 12.5 mg MEQ; P = .009), from PACU to POD 1 (0 mg vs 7.5 mg MEQ; P = .046), and POD 1 to POD 2 (7.5 mg vs 30 mg MEQ; P = .002) when compared with those who received PVBs. Those who received ITM also had lower median pain scores in the PACU and from PACU to POD 1 and a decreased LOS. There were similar rates of adverse events.

CONCLUSIONS

ITM improves postoperative analgesia after abdominally based free flaps when compared to PVBs and may facilitate recovery and earlier discharge.

LEVEL OF EVIDENCE: 3

Rate and predictors of postoperative opioid use and high opioid exposure after surgery in New Zealand: a retrospective study

BACKGROUND

Although excessive opioid use is a significant global health issue, there is a lack of literature on the prescribing patterns for postoperative opioid use and exposure after discharge among surgical patients. This study aimed to examine the rate and predictors of opioid dispensing and high opioid exposure after hospital discharge from surgery in New Zealand (NZ) between January 2007 to December 2019.

METHODS

This is a retrospective population-based cohort study inclusive of all ages and surgical specialties. Data were obtained from the NZ Ministry of Health's national health databases.

RESULTS

1 781 059 patients were included in the study and 20.9% (n = 371 882) of surgical patients received opioids within 7 days after hospital discharge. From those who were dispensed with opioids after hospital discharge, 36.6% (n = 134 646) had high opioid exposure. Orthopaedic surgery (AOR 6.97; 95% CI 6.82-7.13) and history of opioid use (AOR 3.18; 95% CI 2.86-3.53) increased the odds of postoperative opioid dispensing and high opioid exposure respectively. Severe multi-morbidity burden (AOR 0.76; 95% CI 0.73-0.78) and alcohol misuse (AOR 0.84; 95% CI 0.77-0.93) lowered the odds of postoperative opioid dispensing and high opioid exposure respectively.

CONCLUSIONS

Our findings suggest a concerning rate of high opioid exposure among surgical patients after discharge. The predictors for postoperative opioid dispensing and high opioid exposure identified in our study provide insight into opioid prescribing patterns in NZ and inform future postoperative pain management.

Positive Preemptive Analgesia Effectiveness of Pregabalin Combined with Celecoxib in Total Knee Arthroplasty: A Prospective Controlled Randomized Study

Objective

The purpose of the present study (a randomized clinical trial) was to evaluate the preemptive analgesic effects of pregabalin combined with celecoxib in total knee arthroplasty (TKA).

Methods

From January 2019 to June 2021, we enrolled 149 patients who underwent TKA and divided them into four groups: the placebo group (n = 36), celecoxib group (n = 38), pregabalin group (n = 38), and combination group (n = 37). Each group was given the corresponding preemptive analgesia regimen at 12 and 2 hours before surgery. The pain score at rest and upon movement, cumulative dosage of sufentanil, knee range of motion (ROM), high-sensitivityC-reactive protein (hs-CRP) level, and adverse effects were evaluated after TKA to compare the effects of the preemptive analgesia regimens among the four groups.

Results

The pain scores upon movement were significantly lower in the combination group than in the other three groups at 6, 12, 24, and 48 hours after surgery (P < 0.05). The cumulative dose of sufentanil within 48 hours after surgery was lowest in the combined group among the four groups (P < 0.05). Hs-CRP, ROM, and postoperative nausea and vomiting (PONV) were within 72 hours after surgery significantly improved in the combination group compared with those of the three other groups (P < 0.05).

Conclusion

The preemptive analgesia regimen of pregabalin combined with celecoxib had positive effects on improving acute pain and reducing the cumulative dose of opioids after TKA. This trial is registered with ChiCTR2100041595.

Predictors of opioid-free discharge after laparoscopic cholecystectomy

BACKGROUND

Post-discharge opioid requirement after laparoscopic cholecystectomy (LC) is minimal, yet postoperative opioid prescriptions vary and opioid-free discharges are rare.

STUDY DESIGN

Adult patients who underwent LC from 01/2019-12/2019 were reviewed. Univariate and multivariable logistic regression analyses were performed to identify predictors of opioid-free discharge.

RESULTS

Of 393 included patients, 330 were discharged with opioids (median 12 oxycodone 5 mg pills) and 63 were discharged without opioids. One opioid-free discharge patient called for a prescription. Older age (OR = 1.02, 95% CI = 1.002-1.041) and non-elective procedure (OR = 0.35, 95% CI = 0.2291-0.8521) were independent predictors of opioid-free discharge.

CONCLUSION

Significant opportunities for opioid reduction or elimination after discharge from LC exist. Non-elective procedure and older age are predictors of opioid-free discharge, and should be considered when individualizing prescription quantities as surgeons strive to reduce or eliminate opioid overprescription.