Reactions 1680, p12 - 2 Dec 2017 Persistent post-surgical opioid use in Australia More than 10% of patients who receive post-operative opioid treatment continued to use opioids more than 90 days after surgery, according to the results of an Australian questionnaire reported in Anaesthesia and Intensive Care. The questionnaire was administered between October 2015 and June 2016 to a convenience sample of 1013 opioid-naive patients prior to elective surgery. The 970 responders (95.8%) were followed-up at 90 120 days after surgery. There were 102 patients (10.5%) who continued to use opioids for >90 days after surgery. Most of these patients had received orthopaedic surgery (49%) or spinal surgery (41.1%). The most frequently used opioid was paracetamol/codeine (28.4%), followed by oxycodone (17.7%), tramadol (16.7%) and oxycodone/ naloxone (11.8%). Although most patients reported using opioids for pain relief (80.4%), other reasons included to improve sleep (5.9%), to facilitate exercise (1%), or to improve pain as well as sleep (1%) or as well as depression and anxiety (1%). In multivariate analysis, persistent opioid use was associated with receiving orthopaedic surgery (odds ratio [OR] 4.6; 95% CI 2.0, 10.8) or spinal surgery (OR 4.0; 1.7, 9.2) compared with other surgeries, positive GAD-2 scores (OR 2.1; 1.1, 4.1), and attending a preadmission clinic rather than the day surgery unit (OR 3.7; 1.6, 8.6). The authors note that although the last factor may involve confounding factors, "this might be clinically important, as the pre-admission clinic provides an opportunity to target patients for opioid risk stratification and provide interventions aimed at reducing post-surgical opioid use". Persistent opioid use was also associated with higher self-reported pain scores. Compared with a pain score of – – 0 1, the risk increased in patients with a score of 2 3 – – (OR 5.8; 2.9, 11.9), 4 5 (OR 16.2; 7.9, 33.4) or 6 10 (OR 21.2; 10.1, 44.6). "Patients at high risk of persistent post-surgical opioid use should not be deprived of treatment with opioids for severe acute pain," note the authors, "but should be followed more closely after hospital discharge". * NCT02571400 Stark N, et al. Prevalence and predictors of persistent post-surgical opioid use: a prospective observational cohort study. Anaesthesia and Intensive Care 45: 700-706, No. 6, Nov 2017. Available from: URL: http://doi.org/20160715 [pii] 803284973 0114-9954/17/1680-0001/$14.95 Adis © 2017 Springer International Publishing AG. All rights reserved Reactions 2 Dec 2017 No. 1680
Reactions Weekly – Springer Journals
Published: Dec 2, 2017
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