Physicians prescribed less combination, more separate analgesics from 2013 to 2019
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Although the proportion of patients who filled an opioid or nonopioid prescription after surgery remained stable from 2013 to 2019, results showed a shift away from physicians prescribing combination analgesics toward separate analgesics.
“Over the past decade or so, there has been a litany of calls for change and a plethora of prescribing recommendations and so we would have expected to see some decrease in the percentage of patients being prescribed opioids and we did not see that,” Naheed Jivraj, MBBS, MS, clinical fellow in the department of anesthesiology and pain medicine at the University of Toronto, told Healio about results presented at the American Society of Anesthesiologists Annual Meeting.
Jivraj and colleagues reviewed nonopioid and opioid prescriptions filled within 7 days of discharge by patients older than 65 years undergoing one of 14 surgical procedures between 2013 and 2019. Researchers assessed whether patients were prescribed a nonopioid only, an opioid only, separate opioid and nonopioids or combination opioid and nonopioid and determined whether the dose of opioids prescribed postoperatively varied depending on the presence or absence of a nonopioid analgesic prescription.
Researchers calculated the total morphine milligram equivalent dose for the opioid prescribed if patients filled a prescription for an opioid alone, a combination opioid and nonopioid analgesic alone or an opioid prescribed concurrent with a separate, nonopioid analgesic prescription. Researchers adjusted mean opioid dose for age, sex, income quintile, preoperative opioid use, surgery type and comorbidities.
“The first thing that we saw was that there was no real change in the percentage of patients being prescribed either an opioid or a nonopioid after surgery,” Jivraj said. “However, there was a reduction in the dose of opioids prescribed across all of our procedures.”
Researchers also saw a shift away from physicians prescribing combination opioid tablets toward separate tablets, one opioid tablet and one nonopioid tablet, Jivraj said.
“That can have multiple theoretical benefits for patients because you can titrate the dose of each medication to minimize their side effects and allow the patient’s pain to be adequately controlled,” he said.
When the procedures performed were categorized into groups based on whether patients would have high, moderate and low anticipated pain after surgery, this showed patients undergoing low-pain procedures continued to receive a high quantity of opioid prescriptions without any nonopioid adjuncts over time, Jivraj said.
“[This study is] a call to action. So many surgery-specific prescribing recommendations ... suggest the use of some combination of opioid and nonopioid analgesia and so this study should, hopefully, represent an opportunity for improvement among our perioperative physicians, whether those are surgeons or anesthesiologists alike, to increase their use of nonopioid analgesics after surgery in the appropriate patients,” he said.
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Jivraj N, et al. Paper 1018. Presented at: American Society of Anesthesiologists Annual Meeting; Oct. 21-25, 2022; New Orleans.
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