Post-surgical pain scores improve as analgesic opioid use falls

Researchers who conducted a retrospective analysis of data from over 100,000 surgical cases in one university health system have reported that patients’ pain scores improved when physicians administered reduced opioid treatment and increased non-opioid pain treatment.

“There is very clear evidence that people can become opioid dependent because of the drugs they get during and after surgery,” said Marcel Durieux, MD, PhD, one of three anesthesiologists who conducted the study at the University of Virginia Health System in Charlottesville, Virginia. “I think that by substantially limiting opioids during surgery, we’ve made an important step in addressing that problem,” he added.

The investigators reviewed data from 101,484 surgeries conducted between March 2011 and November 2015 in which patients had received general anesthesia.

During the same timeframe, average use of post-operative opioids for such patients in the health system fell 37 percent.

In the post-surgical recovery setting all patients completed self-rated pain questionnaires, using a pain scale of  0-to-10. Over the study period the average pain score declined from 5.5 to 3.8, or a 31 percent improvement, even with the reduction in the use of opioids in the health system.

Interpreting the findings, Durieux said that prior research indicates that opioid treatment has the paradoxical effect of making patients more sensitive to pain, and that reducing the amount of opioid use might lead to eventual improvement in pain scores.

He also noted that, during the study period, the health system enacted a significant 120 per cent/per case average increase in the use of non-opioid pain medications, such as lidocaine and acetaminophen.

The researchers presented their findings in December, 2016 in New York City at  the Post-Graduate Assembly in Anesthesiology.