Postoperative Opioid-Sparing Approach May Prevent Chronic Opioid Use

Opioid sparing may be a feasible approach for postoperative pain management and reduce the risk for chronic opioid use, according to study findings published in Regional Anesthesia Pain Medicine.

Researchers characterized at-home use of opioid rescue medication in acute recovery (1 to 2 days after hospital discharge) in a postoperative opioid-sparing context at a Norwegian hospital to determine whether risk factors for persistent opioid use are related to postoperative use of rescue opioids.

The study included 270 adult patients (57% women; mean [SD] age, 47.5 [14.2] years), who were scheduled for minor outpatient procedures with general anesthesia. The patients were recruited at Kongsberg Hospital in Norway between April 2018 and June 2021. The researchers collected study data at 6 timepoints through phone, email, or in-person surveys: a few weeks before the procedure, approximately 1 hour before the procedure, perioperatively, in the recovery room, in acute recovery, and at long-term follow-up visits at 4 and 30 months.

Patients filled out preoperative questionnaires on their demographics, mood, pain, and experience with opioids. Prior to their procedure, 34% of surveyed patients were opioid-naive, while 60% reported previous opioid use. Only 6% of the patient population reported prior use of opioids for longer than 2 consecutive weeks.

During their procedures, patients received treatment according to standards of care and were surveyed to determine mood and effects of analgesics. In the recovery room, patients received pain medication up to 5 times. At this time, 74% of patients received an analgesic of any kind (opioid or non-opioid), of whom 55% received at least 1 opioid dose. Only 49% of those who received opioids received more than 1 dose. Of the previously opioid-naïve patients, 39% received opioids in the recovery stage, compared with 40% of opioid-experienced patients.

In acute recovery, patients self-reported pain, coping ability, and satisfaction with the hospital. Patients received 2 types of analgesics for at-home use at discharge. The first was a fixed combination of naproxen (500 mg) and esomeprazole (20 mg), and the second was a rescue medication of up to 6 oxycodone pills (5 mg). Patients were instructed to use non-opioid analgesics as much as possible and to only use opioids as needed.

A total of 93.2% of participants were given 1 to 6 pills of opioids as rescue medication for at-home postoperative pain management, but 65% did not use any opioids during acute recovery. The mean age of patients who used rescue opioids in acute recovery was 44.5 years compared with 49.7 years for those who did not. Those who used opioids in acute recovery (72%) reported significantly higher pain intensity for longer than 3 months (both preoperatively and during acute recovery) compared with those who did not (48%) and were more likely to have received opioids in the recovery room (67% vs 26%). Patients who reported opioid use also had increased preoperative anxiety levels, but the difference was not significant compared with those who did not.

At long-term follow-up, patients reported their extended recovery and substance use. The researchers measured pain, pain catastrophizing, mood, potential substance use, general life satisfaction, and mindfulness in day-to-day life, among other factors. During follow-up, 11% of responsive patients (n=218) were using pain medication, of whom 1.8% reported use of opioid-based analgesics.

Although opioid recipients reported significantly higher pain levels prior to and on the day of the surgery, as well as during acute recovery, they reported low pain levels during long-term follow-up. The researchers identified that risk factors for persistent postoperative opioid use, including chronic pain, substance use, affective disturbances, and preoperative pain severity, are closely related to the use of at-home rescue medication.

Study limitations include the reliance on self-reported data. In addition, the low level of opioid exposure among patients precluded analysis of the correlation between previous opioid use and postoperative opioid use.

The researchers concluded, “Exploratory predictive modeling identified frequency of opioids received in the recovery room after surgery as the most important predictor for at-home use of opioid rescue medication, pointing to postoperative pain management in the recovery room as a relevant target for preventive care.” They continued, “Taken together, the high satisfaction, low levels of persistent pain and analgesic use months after surgery, validate the opioid-sparing approach as an efficient pain management scheme within this population…”