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Intraoperative opioid and non-opioid administration patterns and early postoperative pain: A single-center retrospective longitudinal study

Gregory Smith, MD, Marcel E. Durieux, MD, PhD, Siny Tsang, PhD, Bhiken I. Naik, MBBCh


Objective: Characterize changes in intraoperative opioid and non-opioid administration over time and to evaluate self-reported pain scores in the immediate postoperative period.

Design: Single-center retrospective longitudinal study.

Setting: Academic medical center.

Patients, participants: All patients presenting for surgery between 2011 and 2017 in both an inpatient and outpatient setting.

Main outcome measure(s): Determine total intraoperative opioid administration using intravenous oral morphine equivalents standardized to weight and intraoperative non-opioid use. Furthermore, postoperative self-reported pain scores within 2 hours of completion of surgery are reported.

Results: A total of 112,167 individual cases were identified from March 2011 to June 2017. There was a sustained and significant reduction in intraoperative mean and median opioid administration [2011: 0.16 ± 0.15 mg/kg and 0.13 (0-4.92) mg/kg vs 2017: 0.09 ± 0.09 mg/kg and 0.07 (0-4.17) mg/kg]. These effects are seen in emergent vs elective surgery, ambulatory vs inpatient, preoperative opioid use vs no preoperative opioid use, and those with and without intraoperative loco-regional procedures. Although median number of intraoperative non-opioid analgesic agents was unchanged over time, average difference in the number of intraoperative non-opioids increased over time. Finally, pain scores decreased over time [2011: mean (standard deviation) and median (range): 5.1 ± 2.62 and 5.4 (0-10) vs 2017: 3.29 ± 3.27 and 3 (0-10)].

Conclusion: This study confirms that intraoperative opioid use has decreased over time with increased utilization of non-opioid analgesic adjuncts and a commensurate decrease in immediate postoperative pain.


opioids, non-opioids, postoperative pain

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Benyamin R, Trescot AM, Datta S, et al.: Opioid complications and side effects. Pain Physician. 2008; 11: S105-S120.

Angst MS, Koppert W, Pahl I, et al.: Short-term infusion of the mu-opioid agonist remifentanil in humans causes hyperalgesia during withdrawal. Pain. 2003; 106: 49-57.

Chu LF, Clark DJ, Angst MS: Opioid tolerance and hyperalgesia in chronic pain patients after one month of oral morphine therapy: A preliminary prospective study. J Pain. 2006; 7: 43-48.

Hah JM, Bateman BT, Ratliff J, et al.: Chronic opioid use after surgery: Implications for perioperative management in the face of the opioid epidemic. Anesth Analg. 2017; 125: 1733-1740.

Avidan MS, Maybrier HR, Abdallah AB, et al.: Intraoperative ketamine for prevention of postoperative delirium or pain after major surgery in older adults: An international, multicentre, double-blind, randomised clinical trial. Lancet. 2017; 390: 267-275.

Dunn LK, Durieux ME: Perioperative use of intravenous lidocaine . Anesthesiology. 2017; 126: 729-737.

Liu B, Liu R, Wang L: A meta-analysis of the preoperative use of gabapentinoids for the treatment of acute postoperative pain following spinal surgery. Medicine (Baltimore). 2017; 96: e8031.

Naik BI, Tsang S, Knisely A, et al.: Retrospective case-control non-inferiority analysis of intravenous lidocaine in a colorectal surgery enhanced recovery program. BMC Anesthesiol. 2017; 17: 16.

Bjornholdt KT, Jensen JM, Bendtsen TF, et al.: Local infiltration analgesia versus continuous interscalene brachial plexus block for shoulder replacement pain: A randomized clinical trial. Eur J Orthop Surg Traumatol. 2015; 25: 1245-1252.

Rigg JR, Jamrozik K, Myles PS, et al.: Epidural anaesthesia and analgesia and outcome of major surgery: A randomized trial. Lancet. 2002; 359: 1276-1282.

Kehlet H: Multimodal approach to control postoperative pathophysiology and rehabilitation. Br J Anaesth. 1997; 78: 606- 617.

Tang J, Humes DJ, Gemmil E, et al.: Reduction in length of stay for patients undergoing oesophageal and gastric resections with implementation of enhanced recovery packages. Ann R Coll Surg Engl. 2013; 95: 323-328.

Thiele RH, Rea KM, Turrentine FE, et al.: Standardization of care: Impact of an enhanced recovery protocol on length of stay, complications, and direct costs after colorectal surgery. J Am Coll Surg. 2015; 220: 430-443.

Sun EC, Darnall BD, Baker LC, et al.: Incidence of and risk factors for chronic opioid use among opioid-naive patients in the postoperative period. JAMA Intern Med. 2016; 176: 1286-1293.

Brummett CM, Waljee JF, Goesling J, et al.: New persistent opioid use after minor and major surgical procedures in US adults. JAMA Surg. 2017; 152: e170504.

Clarke H, Soneji N, Ko DT, et al.: Rates and risk factors for prolonged opioid use after major surgery: Population based cohort study. BMJ. 2014; 348: g1251.



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