Reduced opioid administration leads to increased pain, opioid use

Editor's Note

A new study led by researchers at Massachusetts General Hospital (MGH) finds reduced opioid administration during surgery unintendedly increased postoperative pain and opioid use.

The retrospective cohort study included 61,249 individuals who underwent noncardiac surgery with general anesthesia from April 2016 to March 2020. The maximal pain score during postanesthesia care unit (PACU) stay and cumulative opioid dose administered during the PACU stay were studied, as well as medium- and long-term outcomes associated with pain and opioid dependence.

Interestingly, the mean opioid administration by year at MGH has decreased over time, likely due to the opioid-free or opioid-sparing initiatives being promoted in postoperative pain management. However, findings indicate increased intraoperative fentanyl and intraoperative hydromorphone were associated with reduced maximum pain scores, and reduced probability and total dosage of opioid administration in the PACU.

Particularly, an increased fentanyl administration led to:

• a lower frequency of uncontrolled pain
• fewer new chronic pain diagnoses 3 months post-surgery
• fewer opioid prescriptions at 30-, 90-, and 180-days post-surgery
• and decreased new persistent opioid use.

“These results raise important questions that require randomized clinical trials to verify causality between intraoperative opioid administration and long-term outcomes,” the researchers indicate, as these findings are contrary to the current trends in opioid use reduction. More studies examining “optimal intraoperative opioid administration on a personalized basis” are recommended.